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Biomedical subjects

N Freemantle

Publications and source records attributed to N Freemantle.

At least 109 records · Page 6Linked to original sources
PubMed1995

Taylorism in a post-modern age?

F.W. Taylor made an early and important contribution to the organisation of work in an industrial society. His ideas, or versions of his ideas, are once again receiving attention. Some commentators even describe a new or neo Taylorism (Pollitt, 1990). This paper argues that the only theoretical justification for the re-introduction of Taylorist strategies in the workplace is found in the notion of the post-modern world; where rationality is replaced by a ritual of signs and work becomes part of that ritual; where form replaces rationale, and strategies for work are governed by processes of survival in the remnants of modernity.

Administrative Personnel↗
PubMed1994

Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide.

OBJECTIVE: To evaluate a policy to reduce the incidence of suicide by means of changing the prescribing of antidepressants from the older tricyclic antidepressants to the routine first line use of selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants. DESIGN: Cost effectiveness analysis with sensitivity analyses using observational data on costs, volume of prescribing, deaths, and toxicity. SETTING: United Kingdom primary care. INTERVENTIONS: Selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants compared with the use of older tricyclics. MAIN OUTCOME MEASURES: Cost per life saved and cost per life year saved. RESULTS: The potential number of lives which may be saved from a switch to the routine first line use of selective serotonin reuptake inhibitors is between 300 and 450 each year. The cost per life year gained ranges from 19,000 pounds to 173,000 pounds, depending on the assumptions used. The cost per life year gained through the use of the newer tricyclic and related antidepressants is considerably lower. CONCLUSIONS: The cost per life year gained through avoiding suicides by the routine first line use of serotonin reuptake inhibitors is likely to be high. The new tricyclics and related drugs are of similar toxicity to the serotonin reuptake inhibitors but are considerably cheaper and so are most cost effective for this purpose. Further research is required on such prescribing. Because of the great uncertainties the shift to considerably more expensive options must be further investigated.

Antidepressive Agents, Tricyclic↗
PubMed1994

Dissemination: implementing the findings of research.

There is an increasing interest in dissemination among researchers, policy makers and information scientists. Dissemination, in the context of health services, can be taken to mean the process of implementing the findings of research. Currently there is a considerable delay in the adoption of evidence on the effectiveness of interventions by professionals in the NHS and other health systems. The development of research designs such as randomized control trials, which can provide the most reliable information on the efficacy of interventions, is a crucial but partial step in the quest to place clinical practice on a more scientific basis. Systematic overviews of interventions bring together the relevant evidence to provide overall estimates of the effectiveness of health service interventions. However, there remains the difficulty of bringing them to the attention of health professionals in a manner which will enable them to improve the effectiveness of their clinical practice. The research evidence suggests that effective dissemination will depend upon using multiple means to communicate key messages rather than a single measure or 'magic bullet'. Information professionals have a role in ensuring the key research evidence is promoted, and that it is as reliable as possible.

Communication↗
PubMed1994

Purchasing and public health: the state of the union.

The purchasing role of health authorities has been in existence for two years and public health physicians are expected to play a central part within this role. While the first year was dedicated to maintaining a "steady state", differences are now appearing between authorities is the way in which purchasing is managed. Based on the views of senior managers and public health physicians working in purchasing authorities, considers how the purchasing process is developing and reports how public health medicine is perceived to be contributing to it. Identifies sub-regional resource allocation as a major factor influencing the purchasing process. Conflicting views were found on the purchasing role of public health medicine, in particular with respect to health needs assessment. As purchasing evolves it remains unclear whether pubic health medicine will come to fulfil a largely technical role, or a more wider one in which it acts as advocate for the population's health.

Data Collection↗
PubMed1993

Short measures.

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Alcoholism↗
PubMed1993

Talking shop.

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Contract Services↗
PubMed1993

Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability.

OBJECTIVE: To examine the evidence for using selective serotonin reuptake inhibitors instead of tricyclic antidepressants in the first line treatment of depression. DESIGN: Meta-analysis of 63 randomised controlled trials comparing the efficacy and acceptability of selective serotonin reuptake inhibitors with those of tricyclic and related antidepressants. MAIN OUTCOME MEASURES: Improvement in mean scores on Hamilton depression rating scale for 53 randomised controlled trials. Pooled drop out rates from the 58 trials which reported drop out by treatment group. RESULTS: Among the 20 studies reporting standard deviation for the Hamilton score no difference was found in efficacy between serotonin reuptake inhibitors and tricyclic and related antidepressants (standardised mean difference 0.004, 95% confidence interval -0.096 to 0.105). The difference remained insignificant when the remaining 33 studies that used the 17 item and 21 item Hamilton score were included by ascribing weighted standard deviations. The odds ratio for drop out rate in patients receiving serotonin reuptake inhibitors compared with those receiving tricyclic antidepressants was 0.95 (0.86 to 1.07). Similar proportions in both groups cited lack of efficacy as the reason for dropping out but slightly more patients in the tricyclic group cited side effects (18.8% v 15.4% in serotonin reuptake group). CONCLUSIONS: Routine use of selective serotonin reuptake inhibitors as the first line treatment of depressive illness may greatly increase cost with only questionable benefit.

Antidepressive Agents, Tricyclic↗
PubMed1993

NHS reforms.

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Health Policy↗