Who contextualises clinical epidemiological evidence? A political analysis of the problem of evidence-based medicine in the layered Dutch healthcare system

We critically examine the discussion on the role of evidence-based medicine (EBM) in healthcare governance. We take the institutionally layered Dutch healthcare system as our case study. Here, different actors are involved in the regulation, provision and financing of healthcare services. Over the last decades, these actors have related to EBM to inform their actor specific roles. At the same time, EBM has increasingly been problematised. To better understand this problematisation, we organised focus groups and interviews. We noticed that particularly EBM’s reductionist epistemology and its uncritical use by ‘professional others’ are considered problematic. However, our analysis also reveals that something else seems to be at stake. In fact, all the actors involved underwrite EBM’s reductionist epistemology and emphasise that evidence should be contextualised. They however do so in different ways and with different contexts in mind. Moreover, the ways in which some actors contextualise evidence has consequences for the ways in which others can do the same. We therefore emphasise that behind EBM’s scientific problematisation lurks a political issue. A dispute over who should contextualise evidence how, in a layered healthcare system with interdependent actors that cater to both individual patients and the public. We urge public administration scholars and policymakers to open-up the political confrontation between healthcare actors and their sometimes irreconcilable, yet evidence-informed perspectives.     

Fertility and digital technology: narratives of using smartphone app ‘Natural Cycles’ while trying to conceive

Fertility awareness apps, which help to identify the ‘fertile window’ when conception is most likely, have been hailed as ‘revolutionising’ women’s reproductive health. Despite rapidly growing popularity, little research has explored how people use these apps when trying to conceive and what these apps mean to them. We draw on in‐depth, qualitative interviews, adopting a critical digital health studies lens (a sub‐field of science and technology studies), to explore the experiences of cisgender women and partners with one such app, Natural Cycles, in the context of their daily lives. We found that many women valued the technology as a ‘natural’, inobtrusive alternative to biomedical intervention, and a means of controlling and knowing their bodies, amid a dearth of fertility‐related education and care. Yet this technology also intervened materially and affectively into the spaces of their lives and relationships and privileged disembodied metrics (temperature) over embodied knowledge. Meanwhile, app language, advertising and cost have contributed to characterising ‘typical’ users as white, heterosexual, affluent, cisgender women without disabilities. In the context of neoliberal shifts towards bodily self‐tracking, technologies appealing as novel, liberating and ‘natural’ to individuals who can access them may nevertheless reproduce highly gendered reproductive responsibilities, anxieties and broader health and social inequalities.     

单片微机化微弱发光测量仪及其在肿瘤研究中的初步应用

单片微机化微弱发光测量仪由中科院生物物理所和北京科龙生物医学技术开发公司研制成功。该仪器适用于肿瘤研究中生物医学样品的微弱发光的测量。测量样品的重复性优于０．８％，稳定性优于０．５％，线性相关系数达０．９９９７，不仅可以进行样品的发光强度测量，还可以进行动力学曲线的测量以及样品发射光谱的测量。光谱在４００ｎｍ－７５０ｎｍ范围内。测量方式可选择手动、半自动和自动计时三种。测量结果表明，荷瘤裸鼠血液微     

组织学实验课教学方法的探讨

目的　 探讨组织学实验课的教学方法 ,提高教学质量。方法　 在组织学实验课上 ,分别采用幻灯讲解、放映电视录像等方法对学生进行辅导 ;要求学生分别做绘镜下实像图、模式图、填图作业 ,在此基础上 ,组织学生进行讨论 ,并列表调查学生对上述 3种作业和 2种辅导的反映。结果　 赞成幻灯讲解辅导的人数 ( 71 % )显著地多于赞成放电视录像辅导的人数 ( 2 9% ) ,具有显著性差异 ( P<0 .0 0 1 )。 61 %的学生认为 ,在节约时间、检查发现学习的薄弱环节、增加复习面、调动学习积极性等方面 ,填图优于绘图。赞成做填图作业的人数 ( 94% )显著地多于赞成做绘图作业的人数 ( 4 % ) ,差异显著 ( P <0 .0 0 1 )。结论　 在目前的条件下 ,作为组织学实验课上的集体辅导 ,电视录像并不能完全代替幻灯讲解 ;让学生做填图作业 ,在节约时间、调动学习积极性、发现学习的薄弱环节、加深学习印象、增加复习的广度等方面明显地优于做绘图作业 ,值得在教学中推广。     

Change in process: bringing about change in health care through action research

• ? A 2-year action-research project aiming to facilitate the management of change was carried out in a district general hospital.
• ? Hospital managers and senior ward nurses had very different views concerning the source of challenges and problems within the hospital organization.
• ? A case-study of nurses' experience of change at ward level was produced as part of the diagnostic phase of the action research.
• ? The results of the case-study indicated that general managers and professionals had different agendas for change hut that there is common ground between them.

     

Reading research critically. I. An introduction to appraisal: designs and objectives

• ? This is the first of two articles providing an introduction to appraising published research critically.
• ? In this paper three styles of research are presented and the basic types of research objectives and designs are briefly described.

     

The development of guidelines for drug and alcohol dependence treatment: affecting policy and practice

The rationale and methodology behind the Australian Quality Assurance Project is described. The Project aimed to develop guidelines for treatment content based on three sources of information: research findings, current practice and expert opinion. The issue of the gap between research and practice is discussed, as well as the role of dissemination in altering clinician behaviour.     

Aspects of the aetiology of congenital heart disease

A concise overview of current knowledge on the aetiology ofcongenital heart disease is provided. At present, only 10 to20% of the cases occurring in neonates can be attributed toknown risk factors. Recurrence within relatives, chromosomalanomalies, genetic disorders, maternal diseases and teratogenexposure are addressed briefly; contemporary research modelsand methods, e.g. embryology and genetics and molecular biology,are referred to. A major innovation has been the introductionof the concept of common pathogenetic pathways. Thus, differentteratogenic factors or risk-factors may affect normal developmentat an identical stage and cause similar malformations. Also,the importance of timing of an event is stressed. If the timeframe of exposure does not coincide with embryogenesis any teratogeniceffect may be missed. Large-scale epidemiological studies on fetuses and neonateswith congenital heart disease are introduced as a third modeof research on the aetiology, although this approach is notused efficiently at present; cases of intra-uterine death canbe considered a valuable source of information that needs furtherattention. Combined, the above three lines of research may proveproductive, but the design of a comprehensive research projectwould need to be handled carefully. Possibilities for preventionof the occurrence of cardiovascular malformations are reported.Through lack of knowledge of causality, at present, only secondaryprevention may be possible and hence deserves attention. However,there appears to be no provision for thorough pre-natal screeningtests for congenital heart disease in an unselected population.