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Moreover buy midamor 45 mg visa, persistent social inequality means that the benefits to self these people experience are not available to those Canadians without the financial and other resources necessary to participate in alternative approaches to health care order midamor 45mg without a prescription. Furthermore midamor 45 mg without a prescription, in all cases cheap midamor 45 mg without prescription, these people had to manage the deviant identities they acquired through their use of alternative therapies. This perspective is particularly appropriate to the questions I address, as my intent is a subjectivist understanding of the experiences of lay people who use alternative health care. Symbolic interactionism was useful in this research, since what distinguishes it from structuralist approaches is its focus on the micro level of society, its concern with the subjective experiences of individuals in interaction, and its emphasis on individuals’ own understandings of reality as a basis for their actions (Blumer 1969). In giving meaning to symbols, the individual is able to interpret the actions of others, conceive his or her own course of action, and anticipate future actions. As individuals interact with each other, meanings become shared, thus allowing people to communicate with each other through the use of significant symbols, such as language, gestures, and appearance. Meaning is not inherent in symbols; rather, it is a negotiated and social product, therefore symbols can hold a multiplicity of meanings. Symbolic interactionism’s subjectivist orientation permits the researcher to gain insight into the processes by which individuals both create, and modify, meaning (Blumer 1969; Maines 1981). Moreover, a qualitative research design was the natural choice for this research, as it ensures that the focus remains on the individual, emphasizing “the value of the person’s own story” (Becker 1996:vi). Such a focus allowed me to form an interpretive understanding of the motives and meanings behind individuals’ participation in alternative approaches to health and healing (Becker 1966). Specifically, I used unstructured interviews as a primary means of data gathering (McCraken 1988). Sufficient interviews were conducted such that themes and patterns in the data were confirmed by informant after infor- mant (Glaser and Strauss 1967). As part of my field notes, I kept track of how I made contact with each informant, enabling me to note any patterns in the data which were a result of friendship or other networks (see Figure 0. Introduction | 5 Image not available The interviews ranged anywhere from an hour to an hour and a half in length. Informant preference to be inter- viewed in the home proved advantageous: in addition to allowing them to be more candid than in other locations, in the privacy of their homes many informants felt comfortable demonstrating various therapeutic techniques involved in the alternative health care they use. I began each interview by asking informants variations of the general question: How did you first become involved in using alternative therapies? I then concentrated on listening, probing to explore issues informants raised and to seek clarification, and noting when there were pauses in the conversation. As Becker (1970b:193) points out, statements volunteered by informants are “likely to reflect the observer’s preoccupations and possible biases less than [those] made in response to” questions posed by the researcher. Thus, the use of unstructured interviews enhanced the validity of this analysis. The sheer amount of information provided by informants guards against researcher bias “by making it difficult for the observer to restrict... The validity of this research was also confirmed by informant review of the findings ensuring that my analysis reflects their beliefs about, and experiences of participation in, alternative approaches to health and healing. Also, when theory is “induced from diverse data,” the researcher is less likely to impose his/her perceptions of reality on the phenomena at hand (Glaser and Strauss 1967:239). Thus the rigour of this study was enhanced through the use of a variety of sources of information in addition to the primary interview data. This information complements the interview data in a variety of ways (Shaffir and Stebbins 1991). For example, my own experiences as a user of alternative therapies provides me with insider awareness that reinforces the validity of this research (Douglas 1976). Further, the participant observation I conducted gave me a deeper familiarity with the various alternative therapies these informants used and practised, including acupuncture, aromatherapy, astrological healing, bagua, Chinese herbal medicine, chiropractic, Christian Science medicine, creative visualization, crystal healing, ear candling, Feldenkrais method, herbal medicine, homeopathy, hypnotherapy, massage, meditation, mid- wifery, naturopathy, psychic healing, reflexology, reiki, the results system, therapeutic touch, vitamin therapy, and yoga—as well as fasting and a variety of other dietary regimes. In the same way, participant observation made me aware of the alternative health care remedies and products that were locally available to informants. For instance, in the spring of 1995 I participated in a yoga session specially designed for people with multiple sclerosis.
The fear of risks and dangers results in both self-imposed restrictions on personal behaviour and in an acceptance of externally-dictated limits on the scope of human activity discount midamor 45 mg overnight delivery. Anthony Giddens proven 45mg midamor, sociologist and intellectual guide to New Labour purchase 45mg midamor, celebrated the emergence of risk 158 CONCLUSION as a force of moral regulation: ‘We can’t return to nature or to tradition buy midamor 45mg amex, but, individually and as collective humanity, we can seek to remoralise our lives in the context of a positive acceptance of manufactured uncertainty’ (Giddens 1994:227). A sense of low expectations has converged with a heightened sense of risk to restrict the scope of individual activity and diminish our common humanity. The impasse reached by Western society in the 1990s was experienced differently by different sections of society. Perceptions were strongly influenced by parallel economic and social developments, in particular by the demise of traditional forms of collectivity and the accelerated erosion of familiar institutions, from the Royal Family to the nuclear family. The decline of old-style class conflict brought an end to long-established patterns of industrial and political conflict. It also removed a key source of cohesion on both sides of the great divide, compounding wider atomising forces to produce an unprecedented degree of individuation in society. If the proletarian solidarity of the trade unions and the labour movement effectively disintegrated, so too did the spirit of class loyalty that had made the Conservative Party such a successful social movement. For this cynical aristocrat, the loss of nerve of the upper crust clique, which had always informally appointed the leader of the Conservative Party, was revealed in the debacle which resulted in the replacement of Mrs Thatcher by John Major in November 1990. The abdication of leadership by the traditional elite of British society has become increasingly apparent throughout society, from industry and commerce to culture and services. In the business enterprise, it became standard practice for directors to defer to management consultants, public relations experts and ethical investment advisers. In a similar spirit of uncertainty, employers called in facilitators and counsellors to deal with workplace conflicts, drew up mission statements in an attempt to discover a sense of purpose, used codes of conduct to regulate working relationships and charters to appeal to customers. In the professions, the crisis of confidence was expressed in the quest for new forms of reassurance through audit, inspection and reaccreditation. In medicine, as we have seen, this has led to the emergence of guidelines, evidence-based medicine, clinical governance and revalidation. It has also encouraged a major expansion of the sphere of medical ethics, as doctors refer decisions in what were formerly regarded as clinical matters to ethical committees (and even to the courts). Thus, technologicial development continues despite the stagnation of intellectual life. However, though there are still many people who are committed to experimentation and innovation, the prevailing climate is suspicious if not hostile to such activities, inducing a remarkably diffident outlook. Scientists, particularly those working in politically sensitive areas such as genetics, are reluctant to take responsibility for their own work, preferring to invite some external agency to regulate it. For the mass of people, the main effect of the stagnation of society has been to foster a sense of apprehension and diminished expectations for the future. If collective aspirations are no longer viable, then the scope for individual aspirations is also reduced. The contemporary preoccupation with the body is one consequence of this: if you cannot do much to change society or your place in it, at least you can mould your own body according to your own inclinations. The consequences of this narcissistic outlook range from the fads for body-building, tattooing and body-piercing to the increasing prevalence of morbid conditions of self-mutilation, anorexia and bulimia (Porter 1999). The intense social concern about health is closely related to the cult of the body: once you give up on any prospect of achieving progress in society, your horizons are reduced to securing your own physical survival: Investing in the body provides people with a means of self- expression and a way of potentially feeling good and increasing the control they have over their bodies. If one feels unable to exert control over an increasingly complex society, at least one can have some effect on the size, shape and appearance of one’s body. The dramatic increase in state intervention in the health-related behaviour of the individual over the past decade has taken place in parallel with the contraction of the traditional sphere of politics. The 160 CONCLUSION ending of the Cold War also brought to an end the polarities of left and right that had dominated parliamentary and electoral politics over the previous century. The unchallenged ascendancy of the capitalist system meant that debates about policy became superfluous and government was reduced to administration. Yet, conservative propagandists immediately felt the loss of their old adversaries and were now forced to find new ways of securing popular approval for a system which had an inescapable tendency to generate social instability and dissatisfaction.
The resuscitation committee The resuscitation committee ● Specialists in: Every hospital should have a resuscitation committee as Cardiology or general medicine recommended in the Royal College of Physicians’ report proven 45mg midamor. The committee should ensure that Emergency medicine hospital staff are appropriately and adequately trained generic midamor 45 mg on line, that Paediatrics there is sufficient resuscitation equipment in good working ● Resuscitation officer order throughout the hospital cheap 45 mg midamor with visa, and that adequate training ● Nursing staff representative ● Pharmacist facilities are available generic 45 mg midamor free shipping. The minutes of the committee’s ● Administrative and support staff meetings should be sent to the medical director or appropriate representative—for example, porters medical executive or advisory committee of the hospital and ● Telephonists’ representative should highlight any dangerous or deficient areas of practice, such as lack of equipment or properly trained staff. Postgraduate deans or tutors (or both) should be ex-officio members of the committee to facilitate liaison on training matters and to ensure that adequate time and money is set The resuscitation committee should receive a aside to allow junior doctors to receive training in resuscitation. Resuscitation provision and The resuscitation officer performance should be regularly reviewed as part of the clinical governance process The resuscitation officer should be an approved instructor in advanced life support, often also in paediatric advanced life support and sometimes in advanced trauma life support. The background of resuscitation officers is usually that of a nurse with several years’ experience in a critical care unit, an operating department assistant, or a very experienced ambulance paramedic. The resuscitation officer is directly responsible to the chair of the resuscitation committee and receives full backing in carrying out the role as defined by that committee. It is essential that a dedicated resuscitation training room is available and that adequate secretarial help, a computer, telephone, fax machine, and office space are provided to enable the resuscitation officer to work efficiently. As well as conducting the in-hospital audit of resuscitation, he or she should be encouraged to undertake research studies to Chair of the resuscitation committee further their career development. Doctors, nurses, and managers do not always recognise the Committee crucial importance of having a resuscitation officer, especially when funding has been a major issue. Training should be Resuscitation officer mandatory for all staff undertaking general medical care. It is likely that many specialties will require formal training in cardiopulmonary resuscitation before a certificate of Training Administration Training room and equipment Secretarial support accreditation is granted in that specialty. It is advisable that the recommendations of the Royal College of Physicians’ report and the recommendations of the Resuscitation team structure 55 ABC of Resuscitation Resuscitation Council (UK) should be implemented in full in The cardiac arrest team all hospitals. All hospitals should have a unique telephone number to be used in case of suspected cardiac arrest. It would ● Specialist registrar or senior house officer be helpful if hospitals standardised this number (222 or 2222) in medicine ● Specialist registrar or senior house officer so that staff moving from hospital to hospital do not have to in anaesthesia learn a new number each time they move. This emergency ● Junior doctor number should be displayed prominently on every telephone. Because the person instigating the call may not know exactly what location they are calling from, the telephone should indicate this—for example, “cardiac arrest, Jenner Hoskin ward, third floor. The hospital resuscitation committee should determine the composition of the cardiac arrest team. In multistorey hospitals those carrying the cardiac bleep must have an override facility to commandeer the lifts. The resuscitation officer must ensure that after any resuscitation attempt, the necessary documentation is accurately completed in “Utstein format. It is essential that the senior doctor and nurse at the cardiac arrest should debrief the team, whether resuscitation has been Practising in the resuscitation training room successful or not. If any member of staff is especially distressed then a confidential counselling facility should be made available through the occupational health or psychological medicine department. Presence of relatives The resuscitation training room It is now accepted by many resuscitation providers and institutions that the relatives of those who have suffered a This room should be totally dedicated to resuscitation training and fully equipped with cardiac arrest may wish to witness the resuscitation attempt. Clear intubation trainers, and other required guidelines are available from the Resuscitation Council (UK) training aids detailing how relatives should be supported during cardiopulmonary resuscitation procedures. Allowing relatives to witness resuscitation attempts seems, in many cases, to allow them to feel that everything possible has been done for their relative even if the attempt at resuscitation is unsuccessful, and may be a help in the grieving process. Do not attempt resuscitation orders For some patients, attempts at cardiopulmonary resuscitation are not appropriate because of the terminal nature of their DNAR orders illness or the futility of the attempt. Every hospital resuscitation ● Hospital’s policy must be agreed with ethics committee should agree a “do not attempt resuscitation” and medical advisory committees (DNAR) policy with its ethics committee and medical advisory ● Discuss with patients or relatives (or both) committee (see Chapter 21). In many cases it may be when appropriate appropriate to discuss the suitability of attempting ● Advance directive or “living will” views must be respected cardiopulmonary resuscitation with the patient or with his or ● DNAR orders must be documented and her relatives in the light of the patient’s diagnosis, the signed by the doctor responsible probability of success, and the likely quality of subsequent life.
Ferrier (1876) mapped the different functions of the macaque brain (a) by direct stimulation of the cortex and transposed the functions to the human cortex (b) midamor 45mg with amex. The motor homunculus produced by Penfield and Rasmussen from direct stimulation studies discount midamor 45mg with amex. Note that the body is distorted and those areas which produce fine motor actions and manipulations (the hand and the mouth) are disproportionately represented order midamor 45 mg with visa. Reverse engineering the human mind 175 shut’ – I know you heard the door midamor 45mg otc, but that was the image not the transla- tion itself. Penfield and Rasmussen were aware of this problem and con- cluded that in these cases stimulation ‘sheds no light upon the function of an area unless the patient is making use of that area at the moment’. What is needed, then, is some way of reverse engineering the brain in action – a means of catching the brain in the act. Another wave of reverse engineering, neuropsychology, began soon after the first and got into full flight with the report by Pierre Paul Broca (1824–1888) that damage to a part of the lower left frontal lobe rendered patients unable to produce speech. The approach taken in neuropsychol- ogy is to investigate the abilities of patients who have suffered brain damage and from the pattern of their deficits to infer something about the function of that region or about the general organisation of the system under investigation. The study of patients with focal brain damage formed perhaps the most important source of knowledge about the organisation and function of the brain for the best part of the twentieth century and the kinds of dissociations demonstrated were both informative and intellectu- ally seductive. Another patient perceived the world totally devoid of colour without suf- fering any marked reductions in movement and form perception. Other specific and curious deficits include the loss of awareness of one half of the body, or of objects, or an inability to name an object presented to the right hand side of the brain when it is disconnected from the left side. All of these examples suggest that the brain is organised into groups of rela- tively specialised areas. In many respects the classic findings of neuropsychology have formed the bedrock of much of what we know about how we see, hear, speak, move and even feel. Nonetheless, neuropsychology has not always influenced theories about how the intact brain carries out tasks. This is partly because nature is a poor surgeon: accidental brain damage is usually spatially diffuse, interrupts several functions, is irreversible and the time of its occurrence cannot be predicted. Another problem with the lesion method in general, even when specific areas can be removed from animals, is that 176 V. Temporal resolution simply refers to the window of time which can be used to look at a func- tion and it is critical when one considers the nature of psychological models of brain function. Our models always contain stages of processing that are part parallel and part serial. In other words, to understand brain processes means understanding them in time as well as space. Knowledge of precisely when the brain carries out specific functions is fundamental to any accurate description of how the brain performs many complex tasks. Indeed the brain may invent some apsects of what you think of as real time. You might think you experience a unified world in which objects have shape and colour and movement – but you are deluded. The brain areas that deal with the different attributes of an object all operate at different paces, perhaps several milliseconds apart (several milliseconds is a long time in the brain – while you’re larding about the brain is doing some impressive housekeeping) and we don’t know how they are brought together in syn- chrony. The stimulation method could not address the role of the elaboration areas and the study of brain damaged patients or lesion studies of animals is hampered by the lack of temporal resolution. What is needed for another wave of reverse engineering, then, is the ability to stimulate the brain while it is doing something, or to be able to reversibly disrupt its function- ing to give the lesion method a temporal dimension. The story of how we are able to achieve both of these takes us back to Faraday. Recall that Faraday discovered electromagnetic induction and we know the brain is a conductor of electricity. It follows that exposing the brain to a changing magnetic field will result in an induced electrical field and therefore neural activity in the brain.