"Some convincing arguments to pass back to nervous customers": the role of the tobacco retailer in the Australian tobacco industry's smoker reassurance campaign 1950-1978.
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BACKGROUND: Epidemiological studies and reports on smoking and health published in the 1950s and 1960s threatened the tobacco industry worldwide, which acted to reassure smokers and counteract mounting evidence that smoking posed a serious risk to smokers' health. OBJECTIVE: To document the use of tobacco retailers (1) as a conduit to pass messages of reassurance onto smokers, and (2) to recruit youth and women into smoking. METHODS: Review of an extensive collection of Australian tobacco retail trade journals (1950-1978) for articles consistent with the industry's efforts to counter messages about smoking and health, and how to attract non-smokers, particularly youth and women. RESULTS: The main arguments advanced in the journals included the notion that air pollution and other substances cause cancer, that "statistics" did not constitute proof in the tobacco health scare, and that the industry was committed to research into the causes of cancer and into developing a "safer" cigarette. CONCLUSIONS: Numerous articles designed to be reiterated to customers were published, arguing against the link between tobacco and ill health. Tobacco retailers, salesmen and retail trade organisations played a significant role in dissembling the tobacco health nexus. Tobacco retail journals may be an important component in tobacco industry misinformation strategies. (+info)
Do patients and expert doctors agree on the assessment of consultation skills? A comparison of two patient consultation assessment scales with the video component of the MRCGP.
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OBJECTIVE: The purpose of this study was to determine whether patient ratings of general practice Registrars' consulting skills are associated with 'expert' scoring using the MRCGP video assessment protocol. METHODS: A cross-sectional observational study of general practice Registrars' consultation skills was carried out in 23 practices in South East Scotland using two types of patient assessment compared with expert assessment of video consultation. The main outcome measures were rank correlation of Registrars' overall level of attainment on the Royal College of General Practitioner (RCGP) video assessment with mean score on the Patient Enablement Instrument (PEI) and mean score on the Consultation Satisfaction Questionnaire (CSQ). RESULTS: The rank correlation of Registrars' mean PEI scores with marks on the RCGP video component was 0.01 (P = 0.97, n = 19) and mean CSQ score 0.05 (P = 0.83, n = 19). There were no adverse comments from patients, but Registrars and trainers found the process onerous. CONCLUSION: No meaningful association was identified between Registrars' score on the RCGP video examination and patient assessment via either the PEI or the CSQ. This suggests that, with regard to measuring quality in the consultation, one or more of the assessments are invalid or that they are measuring different attributes. Further research to elucidate the reasons for the lack of correlation is required. (+info)
Treatment of advanced non-small-cell lung cancer patients with ECOG performance status 2: results of an European Experts Panel.
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BACKGROUND: Platinum-based combination chemotherapy is currently recommended as the standard treatment for patients with advanced non-small-cell lung cancer (NSCLC), but its benefit seems limited to fit patients with a performance status (PS) of 0 or 1. For PS2 patients, there is no consensus on standard treatment. With the aims of reviewing the evidence supporting each of these therapeutic options, possibly reaching a consensus for treatment of PS2 patients affected by advanced NSCLC in clinical practice, and suggesting the priorities for clinical research in this field, an European Experts Panel took place in Avellino, Italy in April 2003. RESULTS: and conclusions On the basis of current evidence, chemotherapy treatment appears justified for patients with advanced NSCLC and PS2. Single-agent chemotherapy (gemcitabine, vinorelbine, taxanes) could be the preferred option, although carboplatin-based or low-dose cisplatin-based doublets may represent alternative options. Stronger evidence is expected from new clinical research specifically focused on PS2 patients. Single-agent chemotherapy should be the standard arm against which experimental treatments are tested in randomised trials dedicated to PS2 patients. High priority should be given to the evaluation of tolerability and efficacy of platinum-based combinations, and to the testing of new biological agents. Another research priority is the improvement of supportive care. Patients strongly need symptomatic improvement: end points such as symptom relief, clinical benefit and quality of life should have a central position in trials dedicated to PS2 NSCLC patients. (+info)
Medico-legal practices in the fifteenth century Dubrovnik.
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We analyzed the beginnings of medico-legal practices in Dubrovnik, using the first eight books of criminal records series Liber de maleficiis from the early 15th century. We also looked into the mechanisms of individual and public control of the issues such as the patient-physician relationship and the control of epidemics. At that time, surgeons rather than physicians reported wounds to the court of justice and, in most cases, provided medical expertise when requested by the authorities. Cold steel weapons were the usual instruments of violent offences, and the most frequently harmed part of the body was the head. The expert testimonies formally satisfied the requirements laid down in Dubrovnik normative acts of the time, but their medical content was poor and the vocabulary was a mixture of lay and professional. Although Dubrovnik medical practitioners wrote simple expert testimonies and did not perform forensic autopsy, their involvement in the control of violence and development of the legal system corresponded to the role played by physicians and surgeons in the leading continental European centers of the period. (+info)
Post-conviction DNA testing: the UK's first 'exoneration' case?
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The routine incorporation of forensic DNA profiling into the criminal justice systems of the United Kingdom has been widely promoted as a device for improving the quality of investigative and prosecutorial processes. From its first uses in the 1980s, in cases of serious crime, to the now daily collection, analysis and comparison of genetic samples in the National DNA Database, DNA profiling has become a standard instrument of policing and a powerful evidential resource for prosecutors. However, the use of post-conviction DNA testing has, until recently, been uncommon in the United Kingdom. This paper explores the first case, in England, of the contribution of DNA profiling to a successful appeal against conviction by an imprisoned offender. Analysis of the details of this case is used to emphasise the ways in which novel forms of scientific evidence remain subject to traditional and heterogeneous tests of relevance and credibility. (+info)
Development of clinical practice guidelines: evaluation of 2 methods.
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The aim of this study was to compare 2 methods for developing a clinical practice guideline (CPG) on the management of asymptomatic, impacted mandibular third molars. Outcome measures were the mean time invested by the participants for each method, the quality of the CPGs measured using the Appraisal of Guidelines for Research and Evaluation (AGREE) indicator and observations of the group discussions. We used a national consensus procedure following the Rand modified Delphi procedure (2 panels) and a local consensus procedure (2 existing dental peer groups). The mean time spent was about equal for the 2 methods. The quality of the CPGs developed by the expert panels was higher than that of the CPGs developed by the dental peer groups. Observation indicated that all group processes were influenced by the chairperson. We concluded that the expert panel method is suitable for developing reliable CPGs on a national or regional level. (+info)
Detecting malingering: a survey of experts' practices.
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A survey addressing practices of 'expert' neuropsychologists in handling financial compensation claim or personal injury litigation cases was carried out. Potential participants were identified by publication history. Responses were obtained from 24 out of the 39 neuropsychologists who were surveyed. Approximately 79% of the respondents reported using at least one specialized technique for detecting malingering in every litigant assessment. Half stated that they always give specialized tests at the beginning of the assessment. The Rey 15-Item test and the Test of Memory Malingering were the most frequently reported measures. Respondents also reported frequent use of 'malingering' indexes from standard neuropsychological tests. Reported base-rates varied, but the majority of respondents indicated that at least 10% of the litigants they assessed in the last year were definitely malingering. Respondents were split on the practice of routinely giving warnings at the outset of assessments that suboptimal performance may be detected. However, when the client's motivational status was suspect, more than half (58.3%) altered their assessment routine at least on some occasions, by encouraging good effort (70.8%) or administering additional SVTs. A minority directly confronted or warned clients (25%), terminated the examination earlier than planned (16.6%), or contacted the referring attorney immediately (29.2%). Respondents almost always stated some opinion regarding indicators of invalidity in written reports (95%). However, 41.7% rarely used the term 'malingering' and 12.5% never used the term. Most respondents (>80%) instead stated that the test results are invalid, inconsistent with the severity of the injury or indicative of exaggeration. (+info)
Ignoring free, appropriate, public education, a costly mistake: the case of F.M. & L.G. versus Barbour County.
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In 2000, the 11th Circuit Court provided the largest single award in special education history to date, approximately $2.5 million, to two teenaged students who were deaf. The students were judged to have been denied a free, appropriate public education (FAPE), having spent their academic careers in generic special education classes for students with multiple disabilities without the benefit of access to a communication system; the services of a certified, qualified teacher of the deaf; or related services. This article describes the case from the perspective of FAPE, least restrictive environment, and due process in the presence of guardians who did not understand the implications of the Individual Education Program (IEP) teams' decisions; presents a chronology of the case; explores the implications for various stakeholders; and discusses the catastrophic impact on the social, emotional, communication, and academic development and earning potential of the students. (+info)