Search PubMed⌕ Search

Biomedical subjects

S McIver

Publications and source records attributed to S McIver.

16 recordsLinked to original sources
PubMed2003

Addiction.

Alcohol and psycho-active substance misuse has far-reaching social, psychological and physical consequences. Advances in neuroimaging technology have allowed neurobiological theories of addiction to become better characterized. We describe the neurobiology of dependence, withdrawal, abstinence and craving states in alcohol, stimulant and opiate misuse. Structural neuroimaging techniques such as CT and MRI with new analytical approaches such as voxel-based morphometry have shown wide-spread changes in stimulant and opiate abuse and atrophy, particularly in the frontal lobes, in alcoholism. Functional neuroimaging techniques such as PET, SPECT and fMRI reveal altered regional cerebral activity by all drugs of abuse. The neurochemistry of addiction, particularly involving dopamine, serotonin, opiate and GABA, has been studied with PET and SPECT and similarities between all drugs of abuse have been found such as reduced dopaminergic markers. The evidence derived from these advances in neuroimaging is likely to herald the emergence of new biological treatments in this important field.

Brain↗
PubMed2001

Public perceptions. The generation claim.

There is a growing perception that support for the NHS is falling off among the young. The evidence for this is not conclusive. Dissatisfaction with the NHS is more likely to be linked to increased expectations rather than lack of social solidarity.

Adolescent↗
PubMed2000

Treatment decisions. Whys and wherefores.

A review of challenges to five health authorities' refusals to fund treatment found none of the health authorities had an explicit process for decision making which would stand up to public scrutiny. None had an appeals procedure for contested decisions. This will become an issue for primary care groups and trusts as they will face the same challenges as HAs which refuse treatment. There is the added complication that the doctors will be acting both as agents for their patients and stewards of the resources for the community of patients they serve. Where there are restrictions on treatment, conflict might be avoided by the use of widely available guidelines. Dilemmas over refusing individual patients treatment will not be entirely resolved by evidence-based decisions.

Decision Making↗
PubMed2000

Public consultation. Consulting room.

The government's consultation exercise over the NHS was rare in attempting to capture the views of a large number of citizens other than through a survey. The exercise raised questions about whether or not the government had a plan for the NHS. In the long term, the government may have to consult the public in the context of rationing.

Attitude to Health↗
PubMed1999

Expert patients. So you think you know it all?

The government's proposal to set up an expert patients programme to enable those with chronic illnesses and disabilities to manage their condition is a welcome step towards greater user involvement. The programme should avoid a medical model and take account of patients' social circumstances. The programme must include evaluation. Health professionals in the UK have yet to embrace patient self-management. To date they have been reluctant to refer service users to self-help groups.

Chronic Disease↗
PubMed1998

Patient surveys. There for the asking.

The government's proposal to survey 100,000 patients a year in order to improve services faces considerable organisational problems. We estimate it will cost 200,000 pounds a year. The simple opinion poll approach should be avoided in favour of a detailed questionnaire. A rolling programme of surveys in specific service areas might be more meaningful than a comprehensive annual survey. The aims of capturing patients' views and comparing performance across the country could prove incompatible.

Government↗
PubMed1995

Information for public choice.

The kind of information the public will need in order to take part in the rationing debate is examined. The public are interested in the debate both as taxpayers and as patients and they can have an input in a number of different ways. Their involvement at the level of general discussions about values and service priorities is problematic, because some of the methods used do not allow participants to ask questions or work through the implications of the information they have access to. The mechanisms for ensuring their involvement in planning service strategies are better known and the information requirements are clear. When patients are given more say in decisions about their treatment and care, they may choose different options to those favoured by health professionals, but more work still needs to be done on developing and presenting complex medical information and helping patients to make decisions.

Attitude to Health↗