PubMed · 15938020
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Douglas Allchin. 2005-06-03. Accommodation or prediction?. https://pubmed.ncbi.nlm.nih.gov/15938020/
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The effectiveness of epilepsy surgery is mostly based on the results of observational studies because an experimental design in surgical patients has several ethical implications. However, observational studies suffer from methodological drawbacks, which prevent meaningful conclusions and represent a serious limitation when data from different reports are pooled for systematic reviews and meta-analyses. These include the retrospective design, the use of referral populations, the small sample size, the enrolment of patients at differing inception points, the use of differing inclusion criteria, differing definitions of prognostic predictors and outcome measures, the unmasked assessment of outcome, the short follow-up, the changing technologies and surgical procedures, and the inadequate statistical methods. With these limitations in mind, a systematic review was performed of epilepsy surgery studies aiming at identifying the positive and negative prognostic predictors of surgical outcome. In this review, extent of surgical resection, abnormal MRI, mesial temporal sclerosis, febrile seizures, EEG/MRI concordance, and tumor were in decreasing order the principal indicators of the success of surgery of epilepsy. By contrast, intracranial monitoring and post-operative discharges tended to predict an unfavorable prognosis. Although the heterogeneity of the study results was fairly low, the results may be affected by pooling of data from heterogeneous reports (different patient series assessed with differing methods) or unexamined or unknown confounders. These data must be considered preliminary and cannot replace well-conducted prognostic studies (representative study populations, well-defined inception cohorts, satisfactory and complete follow-up, prospective design, and standard definition of prognostic factors).
This paper reviews 138 empirical quantitative population-based studies of self-reported racism and health. These studies show an association between self-reported racism and ill health for oppressed racial groups after adjustment for a range of confounders. The strongest and most consistent findings are for negative mental health outcomes and health-related behaviours, with weaker associations existing for positive mental health outcomes, self-assessed health status, and physical health outcomes. Most studies in this emerging field have been published in the past 5 years and have been limited by a dearth of cohort studies, a lack of psychometrically validated exposure instruments, poor conceptualization and definition of racism, conflation of racism with stress, and debate about the aetiologically relevant period for self-reported racism. Future research should examine the psychometric validity of racism instruments and include these instruments, along with objectively measured health outcomes, in existing large-scale survey vehicles as well as longitudinal studies and studies involving children. There is also a need to gain a better understanding of the perception, attribution, and reporting of racism, to investigate the pathways via which self-reported racism affects health, the interplay between mental and physical health outcomes, and exposure to intra-racial, internalized, and systemic racism. Ensuring the quality of studies in this field will allow future research to reveal the complex role that racism plays as a determinant of population health.
PURPOSE: The purpose of this research is to examine the issues of decentralisation in the NHS. DESIGN/METHODOLOGY/APPROACH: Evidence was gathered from an empirical study in order to illustrate the effect of policy reform on relationships at both the central and the local level. In this paper issues were examined in the context of two reforms at the heart of the decentralisation agenda in the English NHS: earned autonomy and the introduction of foundation hospitals. FINDINGS: Past and current policy in the NHS reflects elements of both centralisation and decentralisation. The tension created by such opposing forces has an impact not only on inter-organisational partnership working but also on the balance of power within local health economies. ORIGINALITY/VALUE: Attempts to control the NHS exhibit unresolved contradictions and tensions. This research showed that the challenge for policymakers, managers and clinicians is to manage such tensions.