Keele University

About: Keele University is a education organization based out in Newcastle-under-Lyme, United Kingdom. It is known for research contribution in the topics: Population & Stars. The organization has 11318 authors who have published 26323 publications receiving 894671 citations. The organization is also known as: Keele University.

The science of clinical practice: disease diagnosis or patient prognosis? Evidence about “what is likely to happen” should shape clinical practice

Abstract: Diagnosis is the traditional basis for decision-making in clinical practice Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome The concept of disease as a dichotomous ‘yes’ or ‘no’ is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient’s future outcome Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them Such information embraces non-disease factors and genetic and other biomarkers which influence outcome Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care

Actor-network theory, technology and medical sociology : an illustrative analysis of the metered dose inhaler

Abstract: Actor-network theory is a form of relational materialism that codifies a body of ideas developed in the sociology and history of technology. At its centre is a non-dualistic account of the relation between ‘society’ and ‘technology’. In this view society is produced through the mutually constituting interaction of a wide range of human and non-human entities (including machines and technologies). This paper outlines some of the key ideas of actor-network theory and suggests that they might be usefully incorporated into medical sociology (and/or anthropology). An illustrative example is given which demonstrates some aspects of the application of such a non-dualist approach to a particular medical device, the metered dose inhaler (MDI), widely used in the treatment and management of asthma. Within a shifting network of socio-technical relations the MDI and various human actors are seen to have mutually constituted each other. Competencies were created and distributed and linked to panoptical practices of surveillance, control and modification. These included attempts to change both the technologies and the human actors who came into relationship with it. The intricate and mutually constitutive character of the human and the technological in the processes and relationships of sickness and healing is thus demonstrated.