Search results
Found 19845 matches for
©
CC BY-SA 2.0
Towards a broader agenda for training in critical appraisal
Much progress has been made in recent years towards an evidence-based approach to health care, ie the routine framing of an explicit decision sequence in the clinical encounter, the systematic search for published evidence, and the appraisal of relevant research articles. We argue that this is a commendable but limited milestone, and that training in evidence-based health care, particularly the use of critical appraisal techniques, is in need of a broader agenda. We outline a proposal through which the skills and attitudes needed for the critical appraisal of published articles may be applied to all other aspects of clinical practice, from planning research projects to presenting results and guidelines and peer review of articles submitted for publication.
Narrative Research in Health and Illness
This comprehensive book celebrates the coming of age of narrative in health care. It uses narrative to go beyond the patient's story and address social, cultural, ethical, psychological, organizational and linguistic issues. This book has been written to help health professionals and social scientists to use narrative more effectively in their everyday work and writing. The book is split into three, comprehensive sections; Narratives, Counter-narratives and Meta-narratives.
Understanding barriers to healthy lifestyles in a Bangladeshi community
This article summarises the findings from a large qualitative study in east London. In a series of focus groups involving 147 people, the team explored the perceptions of the Bangladeshi community towards diabetes prevention and healthy living, sought advice from religious leaders and Islamic scholars, and asked healthcare professionals about their experiences of giving lifestyle advice to this target audience. The authors highlight key findings that are particularly relevant to diabetes nurses, and suggest some practical changes that might be implemented by nurses working with people of Bangladeshi origin.
Community based yoga classes for type 2 diabetes: An exploratory randomised controlled trial
Background. Yoga is a popular therapy for diabetes but its efficacy is contested. The aim of this study was to explore the feasibility of researching community based yoga classes in Type 2 diabetes with a view to informing the design of a definitive, multi-centre trial. Methods. The study design was an exploratory randomised controlled trial with in-depth process evaluation. The setting was two multi-ethnic boroughs in London, UK; one with average and one with low mean socio-economic deprivation score. Classes were held at a sports centre or GP surgery. Participants were 59 people with Type 2 diabetes not taking insulin, recruited from general practice lists or opportunistically by general practice staff. The intervention group were offered 12 weeks of a twice-weekly 90-minute yoga class; the control group was a waiting list for the yoga classes. Both groups received advice and leaflets on healthy lifestyle and were encouraged to exercise. Primary outcome measure was HbA1c. Secondary outcome measures included attendance, weight, waist circumference, lipid levels, blood pressure, UKPDS cardiovascular risk score, diabetes-related quality of life (ADDQoL), and self-efficacy. Process measures were attendance at yoga sessions, self-reported frequency of practice between taught sessions, and qualitative data (interviews with patients and therapists, ethnographic observation of the yoga classes, and analysis of documents including minutes of meetings, correspondence, and exercise plans). Results. Despite broad inclusion criteria, around two-thirds of the patients on GP diabetic registers proved ineligible, and 90% of the remainder declined to participate. Mean age of participants was 60 +/- 10 years. Attendance at yoga classes was around 50%. Nobody did the exercises regularly at home. Yoga teachers felt that most participants were unsuitable for 'standard' yoga exercises because of limited flexibility, lack of basic fitness, co-morbidity, and lack of confidence. There was a small fall in HbA1c in the yoga group which was not statistically significant and which was not sustained six months later, and no significant change in other outcome measures. Conclusion. The benefits of yoga in type 2 diabetes suggested in some previous studies were not confirmed. Possible explanations (apart from lack of efficacy) include recruitment challenges; practical and motivational barriers to class attendance; physical and motivational barriers to engaging in the exercises; inadequate intensity and/or duration of yoga intervention; and insufficient personalisation of exercises to individual needs. All these factors should be considered when designing future trials. Trial registration. National Research Register (1410) and Current Controlled Trials (ISRCTN63637211).
Evidence-based policymaking: A critique
The idea that policy should be based on best research evidence might appear to be self-evident. But a closer analysis reveals a number of problems and paradoxes inherent in the concept of "evidence-based policymaking. "The current conflict over evidence-based policymaking parallels a long-standing "paradigm war" in social research between positivist, interpretivist, and critical approaches. This article draws from this debate in order to inform the discussions over the appropriateness of evidence-based policymaking and the related question of what is the nature of policymaking. The positivist, empiricist worldview that underpins the theory and practice of evidence-based medicine (EBM) fails to address key elements of the policymaking process. In particular, a narrowly "evidence-based" framing of policymaking is inherently unable to explore the complex, context-dependent, and value-laden way in which competing options are negotiated by individuals and interest groups. Sociolinguistic tools such as argumentation theory offer opportunities for developing richer theories about how policymaking happens. Such tools also have potential practical application in the policymaking process: by enhancing participants' awareness of their own values and those of others, the quality of the collective deliberation that lies at the heart of policymaking may itself improve. © 2009 by The Johns Hopkins University Press.
Ethnic stereotypes and the underachievement of UK medical students from ethnic minorities: qualitative study.
OBJECTIVE: To explore ethnic stereotypes of UK medical students in the context of academic underachievement of medical students from ethnic minorities. DESIGN: Qualitative study using semistructured one to one interviews and focus groups. SETTING: A London medical school. PARTICIPANTS: 27 year 3 medical students and 25 clinical teachers, purposively sampled for ethnicity and sex. METHODS: Data were analysed using the theory of stereotype threat (a psychological phenomenon thought to negatively affect the performance of people from ethnic minorities in educational contexts) and the constant comparative method. RESULTS: Participants believed the student-teacher relationship was vital for clinical learning. Teachers had strong perceptions about "good" clinical students (interactive, keen, respectful), and some described being aggressive towards students whom they perceived as quiet, unmotivated, and unwilling. Students had equally strong perceptions about "good" clinical teachers (encouraging, interested, interactive, non-aggressive). Students and teachers had concordant and well developed perceptions of the "typical" Asian clinical medical student who was considered over-reliant on books, poor at communicating with patients, too quiet during clinical teaching sessions, and unmotivated owing to being pushed into studying medicine by ambitious parents. Stereotypes of the "typical" white student were less well developed: autonomous, confident, and outgoing team player. Direct discrimination was not reported. CONCLUSIONS: Asian clinical medical students may be more likely than white students to be perceived stereotypically and negatively, which may reduce their learning by jeopardising their relationships with teachers. The existence of a negative stereotype about their group also raises the possibility that underperformance of medical students from ethnic minorities may be partly due to stereotype threat. It is recommended that clinical teachers be given opportunities and training to encourage them to get to know their students as individuals and thus foster positive educational relationships with them.