Why Didn’t Plato Just Write Arguments? The Role of Image-Making in the Dialogues

Several of Plato\u27s dialogues seem to question the moral and epistemic value of image-making. Yet Plato\u27s own word-images are powerful and alluring. I reconsider a conception of Platonic metaphysics in which the visible is denigrated relative to the purely intelligible, and in which only the latter can be an avenue to philosophical enlightenment. Viewing the apparent criticisms of image-making in the context of Plato\u27s own use of images, I argue that his use of images can and does lead to philosophical enlightenment and that images are necessary, in addition to logico-deductive reasoning, because of human limitation

FEDERAL GRAZING REFORM AND AVOIDABLE RISK

Recent rangeland reform attempts have increased ranchers'Â’ uncertainty of retaining grazing permits on federal land. This uncertainty is analyzed with a model of grazing on federal land. Ranchers facing this uncertainty will behave differently than if they were guaranteed the renewal of grazing permits at constant real grazing fees. It is shown that the socially optimal outcome may be achieved by adding avoidable risk through targeted rangeland reform. Rangeland reform attempts that create unavoidable risk can make both ranchers and environmental groups worse off.Agricultural and Food Policy,

Listening

This chapter is about listening to patients, their families, and other health care professionals. Listening skills in history taking are examined, and the process of history taking becomes a case study in communication. Listening to insights offered by other treating practitioners (of all disciplines) or fellow professionals is also discussed. Active listening is the first step to understanding and starting on the assessment and treatment process

A systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge

BACKGROUND Pharmacists’ completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload. DESIGN Systematic literature review and meta-analysis of extracted data. METHODS Medline, CINHAL, EMBASE, AMED, ERIC, SCOPUS, NHS evidence and the Cochrane databases were searched using a combination of Medical Subject Heading (MeSH) terms and free text search terms. Controlled studies evaluating pharmacist-led medication reconciliation in the community after hospital discharge were included. Study quality was appraised using CASP. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively. RESULTS Fourteen studies were included comprising five RCTs, six cohort studies and three pre-post intervention studies. Twelve studies had a moderate or high risk of bias. Increased identification and resolution of discrepancies was demonstrated in the four studies where this was evaluated. Reduction in clinically relevant discrepancies was reported in two studies. Meta-analysis did not demonstrate a significant reduction in readmission rate. There was no consistent evidence of reduction in emergency department attendance or primary care workload. CONCLUSIONS Pharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge but patient outcome or care workload improvements were not consistently seen. Future research should examine the clinical relevance of discrepancies and potential benefits on reducing healthcare team workload

Something to Hang my Life on: The Health Benefits of Writing Poetry for People with Serious Illnesses

Objective: We aimed to explore the effect of a poetry writing program for people who had experienced a serious illness. Method: For this study we randomly assigned 28 volunteer participants with a history of serious illness, usually cancer, to one of two poetry writing workshops. Each group met weekly for 2 hours for 8 weeks. The second group was wait-listed to enable comparison between the two groups. We used the Kessler-10, a measure of wellbeing, before and after the workshops and also interviewed the participants at these times. Results: Participants responded enthusiastically and each group demonstrated an increase in wellbeing over the course of their workshop, moving them from medium to low risk on the K10. Participants enjoyed the challenge of writing and the companionship of other group members. Conclusions: Psychiatrists, especially those working in liaison psychiatry, are in a position to encourage patients who have experienced a serious illness to explore writing as a way of coming to terms with their experiences

Apgar score and the risk of cause specific infant mortality: a population based cohort study of 1,029,207 livebirths

Background<p></p> The Apgar score has been used worldwide as an index of early neonatal condition for more than 60 years. With advances in health-care service provision, neonatal resuscitation, and infant care, its present relevance is unclear. The aim of the study was to establish the strength of the relation between Apgar score at 5 min and the risk of neonatal and infant mortality, subdivided by specific causes.<p></p> Methods<p></p> We linked routine discharge and mortality data for all births in Scotland, UK between 1992 and 2010. We restricted our analyses to singleton livebirths, in women aged over 10 years, with a gestational age at delivery between 22 and 44 weeks, and excluded deaths due to congenital anomalies or isoimmunisation. We calculated the relative risks (RRs) of neonatal and infant death of neonates with low (0–3) and intermediate (4–6) Apgar scores at 5 min referent to neonates with normal Apgar score (7–10) using binomial log-linear modelling with adjustment for confounders. Analyses were stratified by gestational age at birth because it was a significant effect modifier. Missing covariate data were imputed.<p></p> Findings<p></p> Complete data were available for 1 029 207 eligible livebirths. Across all gestational strata, low Apgar score at 5 min was associated with an increased risk of neonatal and infant death. However, the strength of the association (adjusted RR, 95% CI referent to Apgar 7–10) was strongest at term (p<0·0001). A low Apgar (0–3) was associated with an adjusted RR of 359·4 (95% CI 277·3–465·9) for early neonatal death, 30·5 (18·0–51·6) for late neonatal death, and 50·2 (42·8–59·0) for infant death. We noted similar associations of a lower magnitude for intermediate Apgar (4–6). The strongest associations were for deaths attributed to anoxia and low Apgar (0–3) for term infants (RR 961·7, 95% CI 681·3–1357·5) and preterm infants (141·7, 90·1–222·8). No association between Apgar score at 5 min and the risk of sudden infant death syndrome was noted at any gestational age (RR 0·6, 95% CI 0·1–4·6 at term; 1·2, 0·3–4·8 at preterm).<p></p> Interpretation<p></p> Low Apgar score at 5 min was strongly associated with the risk of neonatal and infant death. Our findings support its continued usefulness in contemporary practice

Swimming in a Sea of Hypocrisy?: The Ethical Ambiguity of David Rieff\u27s Memoir

When noted intellectual Susan Sontag died from myelodysplastic syndrome in 2004 aspects of her illness trajectory and death were captured and curated by photographer Annie Leibovitz. The harrowing photographs of Sontag’s diseased body – and later her corpse laid out in a New York mortuary – were included in travelling global exhibitions and were further commodified in Leibovitz’s book which she titled A Photographer’s Life. The historical events of Sontag’s illness and death were therefore (re)written and (re)presented in a way that involved commercial gain. Sontag’s son, the journalist David Rieff, registered his contempt for the perceived exploitation/unmaking of his mother in a number of media interviews, and most tellingly he recorded and referenced it in his own memoir Swimming in a Sea of Death. However, some critics have questioned Rieff’s own integrity, suggesting that rather than serving as a respectful ‘tribute’ or commemoration of his mother, aspects of his textual portrait may also be read as acts of ‘posthumous humiliation’. This paper explores how Rieff, while rightly questioning Leibovitz’s violation of his mother’s privacy, could be said to have added to that humiliation by the further exploitation of Sontag’s fame and by his revelation of aspects of her final illness that she may not have wanted to share

The Place of Patient-Centred Care in Medical Professional Culture: A Qualitative Study

Despite widespread support, the implementation of patient-centred care (PCC) remains a challenge and it is often assumed that further clinical education and culture change are needed. To inform such efforts, we need to know whether the principles underpinning PCC accord with doctors’ personal and cultural values. In this chapter, we report the results of a qualitative interview study of clinicians, conducted in order to establish whether PCC emerges in the narratives of Australian doctors, and, if so, how. Our findings suggest that doctors both understand and value the principles underpinning PCC. This suggests that patient-centeredness is part of the professional culture of medicine, and that those wanting to ensure that this patient-centeredness remains an integral part of practice for succeeding generations of doctors might need to focus not as much on education and culture change as on ensuring that there are structures and processes in place to support PCC