169 research outputs found
Talking therapy: The allopathic nihilation of homoeopathy through conceptual translation and a new medical language
The 19th century saw the development of an eclectic medical marketplace in both the United Kingdom and the United States, with mesmerists, herbalists and hydrotherapists amongst the plethora of medical âsectariansâ offering mainstream (or âallopathicâ) medicine stiff competition. Foremost amongst these competitors were homoeopaths, a group of practitioners who followed Samuel Hahnemann (1982[1810]) in prescribing highly dilute doses of single-drug substances at infrequent intervals according to the âlaw of similarsâ (like cures like). The theoretical sophistication of homoeopathy, compared to other medical sectarian systems, alongside its institutional growth after the mid-19th-century cholera epidemics, led to homoeopathy presenting a challenge to allopathy that the latter could not ignore. Whilst the subsequent decline of homoeopathy at the beginning of the 20th century was the result of multiple factors, including developments within medical education, the Progressive movement, and wider socio-economic changes, this article focuses on allopathyâs response to homoeopathyâs conceptual challenge. Using the theoretical framework of Berger and Luckmann (1991[1966]) and taking a Tory historiographical approach (Fuller, 2002) to recover more fully 19th-century homoeopathic knowledge, this article demonstrates how increasingly sophisticated ânihilativeâ strategies were ultimately successful in neutralising homoeopathy and that homoeopaths were defeated by allopaths (rather than disproven) at the conceptual level. In this process, the therapeutic use of ânosodesâ (live disease products) and the language of bacteriology were pivotal. For their part, homoeopaths failed to mount a counter-attack against allopaths with an explanatory framework available to them
Quantifying Global Drivers of Zoonotic Bat Viruses: A Process-based Perspective
Emerging infectious diseases (EIDs), particularly zoonoses, represent a significant threat to global health. Emergence is often driven by anthropogenic activity (e.g. travel, land use change). Although disease emergence frameworks suggest multiple steps from initial zoonotic transmission to human-to-human spread, there have been few attempts to empirically model specific steps. We create a process-based framework to separate out components of individual emergence steps. We focus on early emergence and expand the first step, zoonotic transmission, into processes of generation of pathogen richness, transmission opportunity and establishment, each with their own hypothesised drivers. Using this structure, we build a spatial empirical model of these drivers, taking bat viruses shared with humans as a case study. We show that drivers of both viral richness (host diversity and climatic variability) and transmission opportunity (human population density, bushmeat hunting and livestock production) are associated with virus sharing between humans and bats. We also show spatial heterogeneity between the global patterns of these two processes, suggesting high priority locations for pathogen discovery and surveillance in wildlife may not necessarily coincide with those for public health intervention. Finally, we offer direction for future studies of zoonotic EIDs by highlighting the importance of the processes underlying their emergence
Safety and contagion in acute psychiatric wards: How the milieu is implicated in the occurrence of clustered safety incidents.
In psychiatry, clustered safety incidents are often attributed to behavioural contagion. Drawing on
Kindermann and Skinnerâs conceptual work in our analysis of staff accounts, we explored whether
clustered safety incidents could be attributable to contagion and the role played by staff and the
psychiatric milieu (as a physical, cultural, and therapeutic space). Our analysis suggests that
whether the clustered incidents identified by staff are attributable to contagion depends on how
broadly the âincidentâ is defined, with clear implications for the over or under identification of
contagion. We also identified the role of staff and the milieu in what was often perceived as
contagion. We argue that the pursuit of safety by creating a predictable milieu may paradoxically
contribute to this clustering of safety incidents and staffsâ perception of them as contagious via the
mechanisms of risk amplification, involuntary convergence (increased exposure to safety incidents),
and depletion of the milieuâs therapeutic potential
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Implementing and evaluating patientâfocused safety technology on adult acute mental health wards
Accessible Summary
What is known on the subject
- Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe.
- Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views.
- Patients and staff are experts and should be included in discussions about how to make wards safer.
What this paper adds to existing knowledge
- We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought.
- The app was easy to use and most people liked the look of it.
- Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app.
What are the implications for practice
- This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down.
- To make the most of the app, staff need to get used to it and bring it into ward routines.
Introduction
Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives.
Aim
Implementation and evaluation of âWardSonarâ, a digital safety-monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real-time safety perceptions to staff.
Method
Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10âweeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits.
Results
Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns.
Discussion
Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post-COVID-19 context.
Implications for Practice
The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real-time data to inform proactive safety interventions
Mapping of poverty and likely zoonoses hotspots
The objective of this report is to present data and expert knowledge on poverty and zoonoses hotspots to inform prioritisation of study areas on the transmission of disease in emerging livestock systems in the developing world, where prevention of zoonotic disease might bring greatest benefit to poor people
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Shared decision-making during childbirth in maternity units: the VIP mixed-methods study
Background
NHS policy emphasises shared decision-making during labour and birth. There is, however, limited evidence concerning how decision-making happens in real time.
Objectives
Our objectives were as follows â create a data set of video- and audio-recordings of labour and birth in midwife-led units; use conversation analysis to explore how talk is used in shared decision-making; assess whether or not womenâs antenatal expectations are reflected in experiences and whether or not the interactional strategies used (particularly the extent to which decisions are shared) are associated with womenâs postnatal satisfaction; and disseminate findings to health-care practitioners and service users to inform policy on communication in clinical practice.
Design
This was a mixed-methods study. The principal method was conversation analysis to explore the fine detail of interaction during decision-making. Derived from the conversation analysis, a coding frame was developed to quantify interactions, which were explored alongside questionnaire data concerning womenâs antenatal expectations and preferences, and womenâs experiences of, and postnatal satisfaction with, decision-making. Semistructured interviews with health-care practitioners explored factors shaping decision-making.
Setting and participants
The study took place in midwife-led units at two English NHS trusts. A total of 154 women (aged â„â16 years with low-risk pregnancies), 158 birth partners and 121 health-care practitioners consented to be recorded. Of these participants, 37 women, 43 birth partners and 74 health-care practitioners were recorded.
Key findings
Midwives initiate the majority of decisions in formats that do not invite womenâs participation (i.e. beyond consenting). The extent of optionality that midwives provide varies with the decision. Women have most involvement in decisions pertaining to pain relief and the third stage of labour. High levels of satisfaction are reported. There is no statistically significant relationship between midwivesâ use of different formats of decision-making and any measures of satisfaction. However, womenâs initiation of decisions, particularly relating to pain relief (e.g. making lots of requests), is associated with lower satisfaction.
Limitations
Our data set is explored with a focus on decision initiation and responses, leaving other important aspects of care (e.g. midwivesâ and birth partnersâ interactional techniques to facilitate working with pain) underexplored, which might be implicated in decision-making. Despite efforts to recruit a diverse sample, ethnic minority women are under-represented.
Conclusions
Policy initiatives emphasising patient involvement in decision-making are challenging to enact in practice. Our findings illustrate that women are afforded limited optionality in decision-making, and that midwives orient to guidelines/standard clinical practice in pursuing particular decisional outcomes. Nonetheless, the majority of women were satisfied with their experiences. However, when women needed to pursue decisions, particularly concerning pain relief, satisfaction is lower. Conversation analysis demonstrates that such âwomen-initiatedâ decision-making occurs in the context of midwivesâ avoiding pharmacological methods of pain relief at particular stages of labour.
Future research
We suggest that future research address the following â the barriers to inclusion of ethnic minority research participants, decision-making in obstetric units, systematic understanding of how pain relief decisions are pursued/resolved, conversation analysis of interactional elements beyond the specific decision-making context, interactional âmarkersâ of the emotional labour and inclusion of antenatal encounters
Development of paediatric non-stage prognosticator guidelines for population-based cancer registries and updates to the 2014 Toronto Paediatric Cancer Stage Guidelines
Population-based cancer registries (PBCRs) generate measures of cancer incidence and survival that are essential for cancer surveillance, research, and cancer control strategies. In 2014, the Toronto Paediatric Cancer Stage Guidelines were developed to standardise how PBCRs collect data on the stage at diagnosis for childhood cancer cases. These guidelines have been implemented in multiple jurisdictions worldwide to facilitate international comparative studies of incidence and outcome. Robust stratification by risk also requires data on key non-stage prognosticators (NSPs). Key experts and stakeholders used a modified Delphi approach to establish principles guiding paediatric cancer NSP data collection. With the use of these principles, recommendations were made on which NSPs should be collected for the major malignancies in children. The 2014 Toronto Stage Guidelines were also reviewed and updated where necessary. Wide adoption of the resultant Paediatric NSP Guidelines and updated Toronto Stage Guidelines will enhance the harmonisation and use of childhood cancer data provided by PBCRs
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A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study
Background
Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives.
Objective(s)
Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety.
Design
Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation.
Setting and methods
Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring.
Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool.
Participants
A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews.
Interventions
Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions.
Results
Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines.
There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patientsâ real-time reports about ward atmosphere.
Limitations
Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results.
Conclusions
WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review.
Future work
The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context
Pilot Study of the Association of the DDAH2 â449G Polymorphism with Asymmetric Dimethylarginine and Hemodynamic Shock in Pediatric Sepsis
Genetic variability in the regulation of the nitric oxide (NO) pathway may influence hemodynamic changes in pediatric sepsis. We sought to determine whether functional polymorphisms in DDAH2, which metabolizes the NO synthase inhibitor asymmetric dimethylarginine (ADMA), are associated with susceptibility to sepsis, plasma ADMA, distinct hemodynamic states, and vasopressor requirements in pediatric septic shock.In a prospective study, blood and buccal swabs were obtained from 82 patients †18 years (29 with severe sepsis/septic shock plus 27 febrile and 26 healthy controls). Plasma ADMA was measured using tandem mass spectrometry. DDAH2 gene was partially sequenced to determine the -871 6g/7 g insertion/deletion and -449G/C single nucleotide polymorphisms. Shock type ("warm" versus "cold") was characterized by clinical assessment. The -871 7g allele was more common in septic (17%) then febrile (4%) and healthy (8%) patients, though this was not significant after controlling for sex and race (p = 0.96). ADMA did not differ between -871 6g/7 g genotypes. While genotype frequencies also did not vary between groups for the -449G/C SNP (p = 0.75), septic patients with at least one -449G allele had lower ADMA (median, IQR 0.36, 0.30-0.41 ”mol/L) than patients with the -449CC genotype (0.55, 0.49-0.64 ”mol/L, p = 0.008) and exhibited a higher incidence of "cold" shock (45% versus 0%, p = 0.01). However, after controlling for race, the association with shock type became non-significant (p = 0.32). Neither polymorphism was associated with inotrope score or vasoactive infusion duration.The -449G polymorphism in the DDAH2 gene was associated with both low plasma ADMA and an increased likelihood of presenting with "cold" shock in pediatric sepsis, but not with vasopressor requirement. Race, however, was an important confounder. These results support and justify the need for larger studies in racially homogenous populations to further examine whether genotypic differences in NO metabolism contribute to phenotypic variability in sepsis pathophysiology
The International Virus Bioinformatics Meeting 2023
The 2023 International Virus Bioinformatics Meeting was held in Valencia, Spain, from 24–26 May 2023, attracting approximately 180 participants worldwide. The primary objective of the conference was to establish a dynamic scientific environment conducive to discussion, collaboration, and the generation of novel research ideas. As the first in-person event following the SARS-CoV-2 pandemic, the meeting facilitated highly interactive exchanges among attendees. It served as a pivotal gathering for gaining insights into the current status of virus bioinformatics research and engaging with leading researchers and emerging scientists. The event comprised eight invited talks, 19 contributed talks, and 74 poster presentations across eleven sessions spanning three days. Topics covered included machine learning, bacteriophages, virus discovery, virus classification, virus visualization, viral infection, viromics, molecular epidemiology, phylodynamic analysis, RNA viruses, viral sequence analysis, viral surveillance, and metagenomics. This report provides rewritten abstracts of the presentations, a summary of the key research findings, and highlights shared during the meeting
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