School of Historical and Philosophical Studies - Research Publications

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    Artistic practices of the Bohol School of Painting: An analytical and archival study of nineteenth-century panel paintings in the Philippines
    Tse, N ; Jett, P ; Winter, J ; McCarthy, B (Archetype Publishing, 2005)
    In the center of the Philippines on the island of Bohol, a unique panel painting practice evolved linking western artistic methods introduced by the Spanish with Filipino knowledge of materials and techniques. The scientific analysis of five nineteenth century panel paintings belonging to the Baclayon Parish was undertaken and combined with an archival investigation of the Parish Archives to develop a better understanding of their provenance. Results illustrate the western construction methods used in the panel paintings with an oil medium as well as the utilization of local materials such as Kedondong wood for the panel support, cotton and bast fiber paper for a gap filler between the wood panels, and a transparent brown hydrocarbon for the ground layer. Some of the pigments identified correlate with the geological deposits from the region and others correspond with the archival church records. Other identified pigments were not referenced in the archives or found locally. The latter indicate the importation of high quality pigments, not of Filipino origin. Further, the good condition of the panels highlight their sound preparation and an environment suited for these particular works.
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    Cluster randomisation or randomised consent as an appropriate methodology for trials in palliative care: a feasibility study [ISRCTN60243484].
    Fowell, A ; Russell, I ; Johnstone, R ; Finlay, I ; Russell, D (Springer Science and Business Media LLC, 2004-04-27)
    BACKGROUND: Although guidelines for the care of the dying patient exist the evidence base to support the guidelines is poor. Some of the factors contributing to this include failure to recruit to trials, protective healthcare professionals and subsequent attrition from trials due to the death of the patients. Recent studies report favourably on the use of cluster randomisation as an appropriate methodology for use in this patient group. METHODS/DESIGN: A feasibility study, exploring two types of randomisation as appropriate methodology for trials involving dying patients. Cluster randomisation and randomised consent will be utilised following a crossover design at two sites, one oncology ward and one Macmillan unit within the Northwest Wales NHS Trust. All patients commencing on the Integrated Care Pathway (ICP) for the Last Days of Life will be eligible for inclusion in the study. Using the hypothesis that it is not necessary to prescribe an anti-emetic medication when setting up a syringe driver for the dying patient, the study will evaluate different models of research methodology. DISCUSSION: The identification of the most appropriate methodology for use in studies concerning this patient group will inform the development of future clinical studies. Furthermore, the outcomes of this feasibility study will inform the development, of a proposal seeking funding for Wales-wide trials in palliative care. The identification of an appropriate methodology will provide a starting point for the establishment of a robust evidence base for the care of the dying patient.
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    Accuracy of prognosis estimates by four palliative care teams: a prospective cohort study.
    Higginson, IJ ; Costantini, M (Springer Science and Business Media LLC, 2002)
    BACKGROUND: Prognosis estimates are used to access services, but are often inaccurate. This study aimed to determine the accuracy of giving a prognosis range. METHODS AND MEASUREMENTS: A prospective cohort study in four multi-professional palliative care teams in England collected data on 275 consecutive cancer referrals who died. Prognosis estimates (minimum - maximum) at referral, patient characteristics, were recorded by staff, and later compared with actual survival. RESULTS: Minimum survival estimates ranged <1 to 364 days, maximum 7 - 686 days. Mean patient survival was 71 days (range 1 - 734). In 42% the estimate was accurate, in 36% it was over optimistic and in 22% over pessimistic. When the minimum estimate was less than 14 days accuracy increased to 70%. Accuracy was related, in multivariate analysis, to palliative care team and (of borderline significance) patient age. CONCLUSIONS: Offering a prognosis range has higher levels of accuracy (about double) than traditional estimates, but is still very often inaccurate, except very close to death. Where possible clinicians should discuss scenarios with patients, rather than giving a prognosis range.
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    Health biotechnology in China -: reawakening of a giant
    Li, ZZ ; Zhang, JC ; Wen, K ; Thorsteinsdóttir, H ; Quach, U ; Singer, PA ; Daar, AS (NATURE PUBLISHING GROUP, 2004-12)
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    Consensus guidelines on analgesia and sedation in dying intensive care unit patients.
    Hawryluck, LA ; Harvey, WRC ; Lemieux-Charles, L ; Singer, PA (Springer Science and Business Media LLC, 2002-08-12)
    BACKGROUND: Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. METHODS: Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). RESULTS: After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. CONCLUSION: Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.
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    Conclusions:: promoting biotechnology innovation in developing countries
    Thorsteinsdóttir, H ; Quach, U ; Daar, AS ; Singer, PA (NATURE PORTFOLIO, 2004-12)
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    Priority setting for new technologies in medicine: A transdisciplinary study
    Gibson, JL ; Martin, DK ; Singer, PA (BMC, 2002-07-18)
    BACKGROUND: Decision makers in health care organizations struggle with how to set priorities for new technologies in medicine. Traditional approaches to priority setting for new technologies in medicine are insufficient and there is no widely accepted model that can guide decision makers. DISCUSSION: Daniels and Sabin have developed an ethically based account about how priority setting decisions should be made. We have developed an empirically based account of how priority setting decisions are made. In this paper, we integrate these two accounts into a transdisciplinary model of priority setting for new technologies in medicine that is both ethically and empirically based. SUMMARY: We have developed a transdisciplinary model of priority setting that provides guidance to decision makers that they can operationalize to help address priority setting problems in their institution.
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    Interdisciplinary research: putting the methods under the microscope.
    Robertson, DW ; Martin, DK ; Singer, PA (Springer Science and Business Media LLC, 2003-10-19)
    BACKGROUND: While the desirability of interdisciplinary inquiry has been widely acknowledged, indeed has become 'the mantra of science policy', the methods of interdisciplinary collaboration are opaque to outsiders and generally remain undescribed. DISCUSSION: Many have analysed interdisciplinarity, especially in relation to the creation of new disciplines and institutions. These analyses are briefly outlined. Still, there currently persists a silence about the methods of interdisciplinary collaboration itself, and the core of this paper proposes a template for such methods. SUMMARY: Breaking this silence--by making the methods of interdisciplinary projects transparent--could further invigorate interdisciplinary research.
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    A randomised controlled trial of a patient based Diabetes Recall and Management System: the DREAM trial: a study protocol [ISRCTN32042030].
    Eccles, M ; Hawthorne, G ; Whitty, P ; Steen, N ; Vanoli, A ; Grimshaw, J ; Wood, L (Springer Nature, 2002-03-21)
    BACKGROUND: Whilst there is broad agreement on what constitutes high quality health care for people with diabetes, there is little consensus on the most efficient way of delivering it. Structured recall systems can improve the quality of care but the systems evaluated to date have been of limited sophistication and the evaluations have been carried out in small numbers of relatively unrepresentative settings. Hartlepool, Easington and Stockton currently operate a computerised diabetes register which has to date produced improvements in the quality of care but performance has now plateaued leaving substantial scope for further improvement. This study will evaluate the effectiveness and efficiency of an area wide 'extended' system incorporating a full structured recall and management system, actively involving patients and including clinical management prompts to primary care clinicians based on locally-adapted evidence based guidelines. METHODS: The study design is a two-armed cluster randomised controlled trial of 61 practices incorporating evaluations of the effectiveness of the system, its economic impact and its impact on patient wellbeing and functioning.
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    1980-2005: bioethics then and now.
    Singer, P ; Kuhse, H (Springer Science and Business Media LLC, 2006-01)
    In this article we examine the role and ethics of communications in planning for an influenza pandemic. We argue that ethical communication must not only he effective, so that pandemic plans can be successfully implemented, communications should also take specific account of the needs of the disadvantaged, so that they are not further disenfranchised. This will require particular attention to the role of the mainstream media which may disadvantage the vulnerable through misrepresentation and exclusion.