The social construction of child maltreatment: the role of medical practitioners

• Summary: This paper explores how medical knowledge in child protection practice operates, in conjunction with social work knowledge and legal knowledge, as a social process of constructing meaning as ‘maltreatment’ (or not) in which the physical body of the child and perceived abnormalities represent ‘evidence’. Through discourse analysis of two case studies, this paper makes explicit and problematizes the social processes by which meanings are given by medical practitioners, social workers, police and parents to material experiences, the preference given to some meanings over others, and the econsequences of particular meanings for children and families and social work practice.

• Findings: Medical, social and legal knowledge are not neutral but embedded in power relations. The case studies show, through a sociological analysis of professional practice in child protection, how preferred versions of knowledge and meaning may override or dismiss alternative meanings, with particular consequences for parents and children and for practice outcomes.

• Applications: The case studies offer opportunities by which critically to engage with child protection knowledge, policy and practice in keeping with contemporary approaches that advocate dialogue, critical reflection and reflexivity, so that professional knowledge and professional power may be deployed constructively rather than oppressively.

Medical image classification using an efficient data mining technique

Data mining refers to extracting or "mining" knowledge from large amounts of data. It is an increasingly popular field that uses statistical, visualization, machine learning, and other data manipulation and knowledge extraction techniques aimed at gaining an insight into the relationships and patterns hidden in the data. Availability of digital data within picture archiving and communication systems raises a possibility of health care and research enhancement associated with manipulation, processing and handling of data by computers.That is the basis for computer-assisted radiology development. Further development of computer-assisted radiology is associated with the use of new intelligent capabilities such as multimedia support and data mining in order to discover the relevant knowledge for diagnosis. It is very useful if results of data mining can be communicated to humans in an understandable way. In this paper, we present our work on data mining in medical image archiving systems. We investigate the use of a very efficient data mining technique, a decision tree, in order to learn the knowledge for computer-assisted image analysis. We apply our method to the classification of x-ray images for lung cancer diagnosis. The proposed technique is based on an inductive decision tree learning algorithm that has low complexity with high transparency and accuracy. The results show that the proposed algorithm is robust, accurate, fast, and it produces a comprehensible structure, summarizing the knowledge it induces.

Dying in hospital: medical failure or nature outcome?

The purpose of this study was to describe patterns of medical and nursing practice in the care of patients dying of oncological and hematological malignancies in the acute care setting in Australia. A tool validated in a similar American study was used to study the medical records of 100 consecutive patients who died of oncological or hematological malignancies before August 1999 at The Canberra Hospital in the Australian Capital Territory. The three major indicators of patterns of end-of-life care were documentation of Do Not Resuscitate (DNR) orders, evidence that the patient was considered dying, and the presence of a palliative care intention. Findings were that 88 patients were documented DNR, 63 patients' records suggested that the patient was dying, and 74 patients had evidence of a palliative care plan. Forty-six patients were documented DNR 2 days or less prior to death and, of these, 12 were documented the day of death. Similar patterns emerged for days between considered dying and death, and between palliative care goals and death. Sixty patients had active treatment in progress at the time of death. The late implementation of end-of-life management plans and the lack of consistency within these plans suggested that patients were subjected to medical interventions and investigations up to the time of death. Implications for palliative care teams include the need to educate health care staff and to plan and implement policy regarding the management of dying patients in the acute care setting. Although the health care system in Australia has cultural differences when compared to the American context, this research suggests that the treatment imperative to prolong life is similar to that found in American-based studies.

Disentangling the stigma of HIV/AIDS from the stigmas of drugs use, commercial sex and commercial blood donation - a factorial survey of medical students in China

Background
HIV/AIDS related stigma interferes with the provision of appropriate care and support for people living with HIV/AIDS. Currently, programs to address the stigma approach it as if it occurs in isolation, separate from the co-stigmas related to the various modes of disease transmission including injection drug use (IDU) and commercial sex (CS). In order to develop better programs to address HIV/AIDS related stigma, the inter-relationship (or 'layering') between HIV/AIDS stigma and the co-stigmas needs to be better understood. This paper describes an experimental study for disentangling the layering of HIV/AIDS related stigmas.

Methods
The study used a factorial survey design. 352 medical students from Guangzhou were presented with four random vignettes each describing a hypothetical male. The vignettes were identical except for the presence of a disease diagnosis (AIDS, leukaemia, or no disease) and a co-characteristic (IDU, CS, commercial blood donation (CBD), blood transfusion or no co-characteristic). After reading each vignette, participants completed a measure of social distance that assessed the level of stigmatising attitudes.

Results
Bivariate and multivariable analyses revealed statistically significant levels of stigma associated with AIDS, IDU, CS and CBD. The layering of stigma was explored using a recently developed technique. Strong interactions between the stigmas of AIDS and the co-characteristics were also found. AIDS was significantly less stigmatising than IDU or CS. Critically, the stigma of AIDS in combination with either the stigmas of IDU or CS was significantly less than the stigma of IDU alone or CS alone.

Conclusion
The findings pose several surprising challenges to conventional beliefs about HIV/AIDS related stigma and stigma interventions that have focused exclusively on the disease stigma. Contrary to the belief that having a co-stigma would add to the intensity of stigma attached to people with HIV/AIDS, the findings indicate the presence of an illness might have a moderating effect on the stigma of certain co-characteristics like IDU. The strong interdependence between the stigmas of HIV/AIDS and the co-stigmas of IDU and CS suggest that reducing the co-stigmas should be an integral part of HIV/AIDS stigma intervention within this context.

Risk items associated with patient falls in oncology and medical settings

The aim of this study was to determine whether items on a falls risk-assessment tool, made up of brief cognitive and physical measures that nurses use in practice, differentiated fallers and nonfallers in oncology and medical settings. A measure of leg muscle strength clearly distinguished between fallers and nonfallers, with the latter having stronger leg muscles. For nursing practice, the assessment of patients' muscle strength seems to be the most useful scale for identifying potential fallers.

An authorization policy management framework for dynamic medical data sharing

In this paper, we propose a novel feature reduction approach to group words hierarchically into clusters which can then be used as new features for document classification. Initially, each word constitutes a cluster. We calculate the mutual confidence between any two different words. The pair of clusters containing the two words with the highest mutual confidence are combined into a new cluster. This process of merging is iterated until all the mutual confidences between the un-processed pair of words are smaller than a predefined threshold or only one cluster exists. In this way, a hierarchy of word clusters is obtained. The user can decide the clusters, from a certain level, to be used as new features for document classification. Experimental results have shown that our method can perform better than other methods.

Social structures of science and approaches to outcomes-based medical research

Recently, two seemingly divergent approaches have emerged in outcomes-based medical research. Proponents of evidence-based medicine (EBM) argue that the most effective treatments will be found by adopting a hierarchical approach that gives pre-eminence to randomized controlled clinical trials, where these are available. Proponents of participatory medical research argue that research undertaken with consumers and other partners in the community will produce the best outcomes. While one approach marginalizes consumer experience the other approach draws consumers into it. EBM assumes a high level of consensus in a scientific community, while participatory medical research relies on co-opting consumer experience. This paper indicates that each approach involves a particular view of social structure in science. The paper uses theories of social relations among scientists for the purpose of critically assessing EBM and the participatory model.

Lack of integration of medical education in Australia: the need for change

The lack of cohesion across health and education sections and national and state jurisdictions is counterproductive to effective national policies in medical education and training. Existing systems in Australia for medical education and training lack coordination, and are under resourced and under pressure. There is a need for a coordinated national approach to assessment of international medical graduates, and for meeting their education and training needs. The links between prevocational and vocational training must be improved. Tensions between workforce planning, education and training can only be resolved if workforce and training agencies work collaboratively. All prevocational positions should be designed and structured to ensure that service, training, teaching and research are appropriately balanced. There is a need for more health education research in Australia.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.