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The purpose of this paper is to describe recent passage of a private member's bill that can put Canada on a different path from the USA in attempting to resolve conflict that arose over how an influential clinical practice guideline for Lyme disease was developed.

Narrative review.

Critical appraisal of pertinent scientific literature is fundamental to the production of evidence-based practice guidelines. Perception of fairness and transparency in a guideline development process is fundamental to wide acceptance. Allegations of conflicts of interest and excluding opposing views in development of Lyme disease guidelines led to legislative interventions after insurers started basing denial of claims and licensing boards started responding to complaints against physicians whose treatment regimens were inconsistent with guideline statements on chronic Lyme disease. Opposing sides are both faced with limitations in available research evidence. Claims and counterclaims about availability of impartial subject matter experts free of vested interests arose; however, this has been compounded by failures in communication channels. Perhaps most importantly, and the focus of this viewpoint, wide perception among those afflicted of a flawed guideline development process makes it unlikely that all sides can reach agreement on this path. Canada, unlike the USA, is taking steps to include all stakeholders (including representatives of the medical community and of patients’ groups) in a review meeting to develop a comprehensive national framework.

This situation provides a noteworthy example of defining best practice in the difficult situations where stakes are high, diagnostic tools are flawed, some of those identified as experts have vested interests, and patients with unmet needs feel excluded.

The next steps in Canada bear watching, both in terms of potentially resolving key conflicts around the one guideline document in question, and also as a potential model for a more successful guideline development process.

The purpose of this paper is to provide an overview of the content of the current issue of CGIJ.

This review is prepared by the review editor to highlight key points within each article.

Enables readers to scan content and select articles of most interest or relevance to their needs.

CGIJ is the only Emerald health journal providing this service to its readers.

Discusses environmental factors which may have harmful effects on the cardiovascular system and cause acute or chronic disease. Classifies these factors as chemical, physical, biological and psychosocial. Concentrates on describing the chemical, physical and biological elements which directly cause cardiovascular diseases, such as nicotine and carbon monoxide (chemical); temperatue and electricity (physical) and viral infections such as maternal coxsackie (biological). Concludes by stressing the need for more intensive studies on this subject.

There are several infectious agents in the environment that can cause persistent infections in the host. They usually cause their symptoms shortly after first infection and later persist as silent viruses and bacteria within the body. However, these chronic infections may play an important role in the pathogenesis of schizophrenia and Tourette's syndrome (TS). We investigated the distribution of different neurotrophic infectious agents in TS, schizophrenia and controls. A total of 93 individuals were included (schizophrenic patients, Tourette patients and controls). We evaluated antibodies against cytomegalovirus (CMV), herpes-simplex virus (HSV), Epstein-Barr virus, Toxoplasma, Mycoplasma and Chlamydia trachomatis/pneumoniae. By comparing schizophrenia and TS, we found a higher prevalence of HSV (P=0.017) and CMV (P=0.017) antibodies in schizophrenic patients. Considering the relationship between schizophrenia, TS and healthy controls, we showed that there are associations for Chlamydia trachomatis (P=0.007), HSV (P=0.027) and CMV (P=0.029). When all measured viruses, bacteria and protozoa were combined, schizophrenic patients had a higher rate of antibodies to infectious agents than TS patients (P=0.049). Tourette and schizophrenic patients show a different vulnerability to infectious agents. Schizophrenic patients were found to have a higher susceptibility to viral infections than individuals with TS. This finding might point to a modification in special immune parameters in these diseases.

Spotlights the existence of “invisible” chronic illness (ICI) in organizations and, in particular, how disclosure of these conditions presents a potentially traumatizing dilemma for affected individuals. “Damned if they do, damned if they do not”, the person with “invisible” chronic illness (PwICI) risks deviant labelling, stigmatization and discrimination if they disclose a stigmatizing condition, and real threats to physical and emotional well‐being if they do not. Arguments for and against disclosure are framed, with some notes underscoring the western capitalist philosophy that efficiency in organizations must predominate, regardless of the cost to the individual. The attention of management scholars and practitioners is drawn to the“pain of silence” at a time when chronic illness is increasing, yet little understanding of the working life of the PwICI exists.

This paper sets out to provide a brief guide to brain function and the main causes of brain dysfunction likely to be encountered in social care and neurodisability practice. For the first issue of Social Care and Neurodisability, it was felt that such an overview paper serving both as a self‐contained aide memoire, and as a ‘signpost’ for other relevant resources, would be a useful tool to sit alongside any subsequent articles published in the Journal and provide some relevant brain function context. We have drawn on clinical experience, key references and the growing area of internet‐based resources in order to provide what is hopefully an accessible paper in the spirit of the ubiquitous ‘Made Simple’ series.

This paper seeks to address how and why trust relations in the NHS may be changing and presents a theoretical framework for exploring them in future empirical research.

This paper provides a conceptual analysis. It proposes that public and patient trust in health care in the UK appears to be shaped by a variety of factors. From a macro perspective, any changes in levels of public trust in health care institutions appear to derive partly from top‐down policy initiatives that have altered the way in which health services are organised and partly from broader social and cultural processes. A variety of policy initiatives, including the introduction of clinical governance and the resulting use of performance management to scrutinise and change clinical activity, increasing patient choice and involvement in decision‐making regarding their care, are examined for how they have changed the context for trust relations within the NHS.

It is argued that these policy initiatives have produced a new context for trust relations within the NHS, shifting the inter‐dependence and distribution of power between patients, clinicians, and mangers and changing their vulnerability to each other and to health care institutions. The paper presents a theoretical framework based on current policy discourses which illustrates how new forms of trust relations may be emerging in this new context of health care delivery, reflecting a change in motivations for trust from affect based to cognition based trust as patients, clinicians and managers become more active partners in trust relations. The framework suggests that trust relations in all three types of relationship in the “new” modernised NHS might, in general, be particularly characterised by an emphasis on communication, providing information and the use of “evidence” to support decisions in a reciprocal, negotiated alliance.

The paper examines the drivers for change in trust in health care relations in the UK and develops a theoretical framework for the emergence of new trust relations that can be subsequently explored through empirical research.

Modern health care presents challenges for science and technology that go well beyond surgical procedures and physiological monitoring. But although technology is making a rod for policymakers’ backs, it may also be throwing them a lifeline. The research focus is increasingly on information and communications technologies, which are opening up new possibilities in preventive health, self‐diagnosis and even remote surgery. For a public accustomed to paternalistic medicine, the redistribution of R&D resources may come as a shock – but Europe’s overstretched health services need more than sticking plaster solutions.

Purpose – The authors examine framing and narrativization in news coverage of health threats to assess variations in news discourse for known, emerging and novel health risks. Methodology/Approach – Using the analytical categories of known, emerging, and novel risks the authors discuss media analyses of anti-vaccination, antimicrobial resistance (AMR), and Covid-19. Findings – Known risks are framed within a biomedical discourse in which scientific evidence underpins public health guidelines, and following these directives prevent risk exposure while non-compliance is characterized as immoral and risky. News coverage of emerging risks highlights public health guidelines but fails to convey their importance as the risks seem too distant or abstract. Media coverage of novel risks is characterized by the ubiquity of uncertainty, which emerges as a “master frame” under which all incidents and events are subsumed. Stories about novel risks highlight the fluid and changing nature of scientific knowledge, which has the unintended effect of fueling uncertainty as studies and experts contradict each other. Originality/Value – This chapter introduces a new analytical framework for examining how media stories represent public health risks, along with previously unpublished analysis of media coverage about AMR and Covid-19. This chapter provides insight about the nature of risk discourses involving media, public health officials, activists, and citizens.