"There's never been a more pressing time to question every aspect of our inadequate democracy"- Polly Toynbee "This important book shows the many challenges democracy faces in a world of populism and ...radical digital change" - Margaret Hodge 2018 saw celebrations of the centenary of the Representation of the People Act which marked a decisive step towards full universal suffrage - this collection of essays explores the problems of democracy and suggests ways it might now be extended and deepened. Investigates if democracy is an unfinished revolution and if democratic politics is currently in retreat Demonstrates how democratic politics is once again under attack - this time from populist nationalists, authoritarian rulers and new forms of political communication Argues that if we lose the art of active citizenship, we will lose the freedoms and the rights which democracy has bestowed
Austerity as statecraft Gamble, A.
Parliamentary affairs,
01/2015, Letnik:
68, Številka:
1
Journal Article
Recenzirano
After 2010 George Osborne put deficit reduction and control of debt at the centre of his economic strategy, announcing a much more radical fiscal retrenchment than the plan inherited from Alastair ...Darling. The key reason for this was political. Osborne sought to redefine the terms of the debate on economic policy, enabling the Coalition to blame the recession on Labour and to create a new narrative to bolster its claim to economic competence. He failed to achieve his fiscal targets, but his statecraft was highly successful, allowing him to claim the credit when recovery finally started in 2014.
The consequences of the BREXIT vote in June 2016 will take many years to be fully understood. The focus of the debate has shifted from whether there should be a BREXIT at all to what kind of BREXIT ...the UK should now seek to achieve. The result of the referendum and the Brexit election of 2017 has already had a profound effect on all the UK's main political parties, and has raised difficult questions about Britain's role in the world, its governance, its political economy, and the future of the United Kingdom. This article will assess the changes which have already taken place, and will ask whether BREXIT will have lasting consequences for British politics and British government. Will it come to be seen as a watershed in the political development of the UK, or only an episode in a continuous process of evolution?
To investigate whether intensive supervised rehabilitation following ACL reconstruction leads to superior self-reported function and sports participation compared to less supervised rehabilitation.
...Systematic review and meta-analysis.
We included randomised controlled trials (RCTs) comparing supervised rehabilitation to rehabilitation with a similar protocol that used less supervised sessions for athletes following ACL reconstruction. Two reviewers independently screened studies and extracted data. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate methodological quality and GRADE to evaluate overall quality of evidence. Self-reported function and sports participation were the primary outcomes. Data were pooled using random effects meta-analyses.
Our search retrieved 4075 articles. Seven articles reporting on six RCTs were included (n=353). Very-low to low-certainty evidence suggests intensive supervised rehabilitation is not superior to less supervised rehabilitation following ACL reconstruction for improving self-reported function, sports participation, knee flexor and extensor strength, range of motion, sagittal plane knee laxity, single leg hop performance, or quality of life.
Based on uncertain evidence, intensive supervised rehabilitation is not superior to less supervised rehabilitation for athletes following ACL reconstruction. Although high-quality RCTs are needed to provide more certain evidence, clinicians should engage athletes in shared decision making to ensure athletes’ rehabilitation decisions align with current evidence on supervised rehabilitation as well as their preferences and values.
Infographics have become an increasingly popular method to present research findings and increase the attention research receives. As many scientific journals now use infographics to boost the ...visibility and uptake of the research they publish, infographics have become an important tool for medical education. It is unknown whether such infographics convey the key characteristics that are needed to make useful interpretations of the data such as an adequate description of the study population, interventions, comparators and outcomes; methodological limitations; and numerical estimates of benefits and harms. This study described whether infographics published in peer-reviewed health and medical research journals contain key characteristics that are needed to make useful interpretations of clinical research.
In this cross-sectional study, we identified peer-reviewed journals listed in the top quintile of 35 unique fields of medicine and health research listed in the Journal Citation Reports database. Two researchers screened journals for the presence of infographics. We defined an infographic as a graphical visual representation of research findings. We extracted data from a sample of two of the most recent infographics from each journal. Outcomes were the proportion of infographics that reported key characteristics such as study population, interventions, comparators and outcomes, benefits, harms, effect estimates with measures of precision, between-group differences and conflicts of interest; acknowledged risk of bias, certainty of evidence and study limitations; and based their conclusions on the study's primary outcome.
We included 129 infographics from 69 journals. Most infographics described the population (81%), intervention (96%), comparator (91%) and outcomes (94%), but fewer contained enough information on the population (26%), intervention (45%), comparator (20%) and outcomes (55%) for those components of the study to be understood without referring to the main paper. Risk of bias was acknowledged in only 2% of infographics, and none of the 69 studies that had declared a conflict of interest disclosed it in the infographics.
Most infographics do not report sufficient information to allow readers to interpret study findings, including the study characteristics, results, and sources of bias. Our results can inform initiatives to improve the quality of the information presented in infographics.
What are the effects of diagnostic labels and advice, and interactions between labels and advice, on perceived need for shoulder surgery for rotator cuff disease?
2×2 factorial online randomised ...experiment.
People with shoulder pain.
Participants read a scenario describing a patient with rotator cuff disease and were randomised to bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice, and rotator cuff tear label plus treatment recommendation. Guideline-based advice included encouragement to stay active and positive prognostic information. Treatment recommendation stressed that treatment is needed for recovery.
Perceived need for surgery (primary outcome), imaging, an injection, a second opinion and to see a specialist; and perceived seriousness of the condition, recovery expectations, impact on work performance and need to avoid work.
A total of 2,024 responses (99.8% of 2,028 randomised) were analysed. Labelling as bursitis (versus rotator cuff tear) decreased perceived need for surgery (mean effect –0.5 on a 0-to-10 scale, 98.3% CI –0.7 to –0.2), imaging and to see a specialist, and perceived seriousness of the condition and need to avoid work. Guideline-based advice (versus treatment recommendation) decreased perceived need for surgery (mean effect –1.0, 98.3% CI –1.3 to –0.7), imaging, an injection, a second opinion and to see a specialist, and perceived seriousness of the condition and recovery expectations. There was little to no evidence of an advice label interaction for any outcome.
Labels and advice influenced perceived need for surgery and other secondary outcomes in people with rotator cuff disease, with larger effects for advice. There was evidence of little or no interaction between labels and advice for any outcome, but the additive effect of labels and advice appeared large for some outcomes (eg, perceived need for imaging and perceived seriousness of the condition).
ACTRN12621001370897.
AimTo develop and user test an evidence-based patient decision aid for children and adolescents who are considering anterior cruciate ligament (ACL) reconstruction.DesignMixed-methods study ...describing the development of a patient decision aid.SettingA draft decision aid was developed by a multidisciplinary steering group (including various types of health professionals and researchers, and consumers) informed by the best available evidence and existing patient decision aids.ParticipantsPeople who ruptured their ACL when they were under 18 years old (ie, adolescents), their parents, and health professionals who manage these patients. Participants were recruited through social media and the network outreach of the steering group.Primary and secondary outcomesSemistructured interviews and questionnaires were used to gather feedback on the decision aid. The feedback was used to refine the decision aid and assess acceptability. An iterative cycle of interviews, refining the aid according to feedback and further interviews, was used. Interviews were analysed using reflexive thematic analysis.ResultsWe conducted 32 interviews; 16 health professionals (12 physiotherapists, 4 orthopaedic surgeons) and 16 people who ruptured their ACL when they were under 18 years old (7 were adolescents and 9 were adults at the time of the interview). Parents participated in 8 interviews. Most health professionals, patients and parents rated the aid’s acceptability as good-to-excellent. Health professionals and patients agreed on most aspects of the decision aid, but some health professionals had differing views on non-surgical management, risk of harms, treatment protocols and evidence on benefits and harms.ConclusionOur patient decision aid is an acceptable tool to help children and adolescents choose an appropriate management option following ACL rupture with their parents and health professionals. A clinical trial evaluating the potential benefit of this tool for children and adolescents considering ACL reconstruction is warranted.
ObjectivesTo explore how people perceive different advice for rotator cuff disease in terms of words/feelings evoked by the advice and treatment needs.SettingWe performed a content analysis of ...qualitative data collected in a randomised experiment.Participants2028 people with shoulder pain read a vignette describing someone with rotator cuff disease and were randomised to: bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice and rotator cuff tear label plus treatment recommendation. Guideline-based advice included encouragement to stay active and positive prognostic information. Treatment recommendation emphasised that treatment is needed for recovery.Primary and secondary outcomesParticipants answered questions about: (1) words/feelings evoked by the advice; (2) treatments they feel are needed. Two researchers developed coding frameworks to analyse responses.Results1981 (97% of 2039 randomised) responses for each question were analysed. Guideline-based advice (vs treatment recommendation) more often elicited words/feelings of reassurance, having a minor issue, trust in expertise and feeling dismissed, and treatment needs of rest, activity modification, medication, wait and see, exercise and normal movements. Treatment recommendation (vs guideline-based advice) more often elicited words/feelings of needing treatment/investigation, psychological distress and having a serious issue, and treatment needs of injections, surgery, investigations, and to see a doctor.ConclusionsWords/feelings evoked by advice for rotator cuff disease and perceived treatment needs may explain why guideline-based advice reduces perceived need for unnecessary care compared to a treatment recommendation.
The Future of Conservatism? Gamble, Andrew
The Political quarterly (London. 1930),
January/March 2024, 2024-01-00, 20240101, Letnik:
95, Številka:
1
Journal Article
Recenzirano
The Case for Conservatism is the first report of the Onward think tank's Commission on The Future of Conservatism. It examines present discontents and offers a set of principles for addressing them. ...It argues that Conservatives need to shift their ideological position away from the economic liberalism of Margaret Thatcher and the social liberalism of David Cameron and adopt a position which is socially conservative and economically interventionist in order to rebuild a successful electoral coalition and an effective programme for government. They seek to re‐found Conservatism on the pillars of family, community and nation, and the obligations of citizenship rather than the freedom of the individual. They provide a distinctive voice on where Conservatism has gone wrong and how it should change, but they may struggle to become the dominant voice shaping the party's future, because the doctrines of economic liberalism still command strong support.
PDF
