Journal of evaluation in clinical practice
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This commentary on Sturmberg and Mercuri's paper 'Every Problem is Embedded in a Greater Whole' [1] argues that those authors have approached complexity from a largely mathematical perspective, drawing on the work of Sumpter. Whilst such an approach allows us to challenge the simple linear causality assumed in randomised controlled trials, it is itself limited. ⋯ It overlooks, for example, how science itself is historically and culturally shaped and how values-driven misunderstandings and conflicts are inevitable when people with different world views come together to try to solve a problem. This paper argues that the mathematical version of complexity thinking is necessary but not sufficient in medical research, and that we need to enhance such thinking further with attention to human values.
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What is known about how the level of social support, which is among the factors affecting medication adherence, affects medication adherence is limited. ⋯ Understanding the effect of perceived social support on immunosuppressive medication adherence is important for designing future interventions to increase immunosuppressive medication adherence.
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This paper examines the concept of centredness in health care, with a particular focus on person-centred care. While the principle of centring care is widely accepted, the concept of a 'centre' remains ambiguous, complicating its implementation. The paper defines centredness, questions the necessity of a central focus and explores alternative models. ⋯ Distributed care offers flexibility and inclusivity, but it raises challenges about coordination and the potential emergence of a new implicit centre: distribution itself. Hybrid models combining elements of centred and distributed care offer a path forward. Empirical research is needed to compare these approaches, with the aim of developing more responsive and adaptable systems to address diverse and complex needs for health care.
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Equating health with complete physical, mental and social well-being, as defined by the WHO, has played an important role in the development of healthcare systems in Western countries. However, this definition has contributed to the rise of the myth of well-being, increasing the demand on healthcare systems and raising the risk of medicalizing all aspects of life. Additionally, equating health with complete well-being is conceptually flawed for two important reasons. ⋯ While there are various approaches to defining health, the crucial issue is that each definition should include states of unwell-being. Incorporating this perspective would represent a paradigm shift in the field of health, fostering more realistic expectations and reducing the risk of medicalization.
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An increasing number of UK residents are travelling overseas to access medical treatments, the negative health consequences of which are largely managed by NHS doctors. ⋯ Amongst other requirements, this paper finds that NHS doctors must counsel those considering medical tourism overseas on the risks of doing so, and existing efforts to do so should be increased to reflect the increasing prevalence of medical tourism overseas by UK residents and the associated negative health consequences.