Search results

The aim of this paper is to focus on the ethical issues raised by the removal of anonymity from sperm donors. The increasing currency of a 'right to genetic truth' is clearly visible in the drive to revise the legislation on donor anonymity in Western and European countries. The ethical debate is polarized between the 'right to privacy' of the donor or parent and the 'right to know' of the prospective child. However, it is evident that religious, social and cultural attitudes have an overarching impact on attitudes towards sperm donation generally and anonymity specifically. In Asian countries, the social and cultural heritage is hugely diverse and different from those of the West. This review considers the research exploring the complexity of ethical issues informing this debate, and argues that parent's decisions to reveal donor insemination origins to their children are highly complex and relate to a range of social and cultural attitudes that have not been addressed within the policy to remove anonymity from sperm donors.

I aim here to explore the area of `other people's voices' in interview text through a comparative discussion of the work of George Mead and the Russian philosopher and theorist Mikhail Bakhtin. Specifically, I aim to outline Mead and Bakhtin's theories of reflective subjectivity, or how we recognize our self by looking back upon our experience. To explore the relative concepts of reflective subjectivity, I analyse selective quotes from the transcripts of interviews conducted with people who have received donor insemination about their views and experiences of donor anonymity. I conclude that the choices demonstrated in the interview data are, to use Bakhtin's term, answerable. The anticipation of response in dialogic forms represented in other people's voices is a potentially creative process and more than seeking agreement with the generalized other of the community. Bakhtin's unique theorizing contributes to our understanding of the ethical dimensions of everyday life.

Posthumanism offers a unique opportunity to examine the relationship between dead and living bodies. In this article, we explore one setting in which matter – conventionally considered as 'dead', demonstrates its continued vitality: the anatomical dissection room. Using data from interview transcripts, we report on the affect (capacities to affect and be affected) within this space, to reveal the micropolitics of dissection. Analysis of the 'dissection-assemblage' reveals how interactions between the living – students, teachers, technicians – and dead bodies not only produce knowledge and understanding of human anatomy but also show how the dead body gains new capacities to affect living bodies psychologically, emotionally and physiologically. While conventional humanist discussions of dissection have addressed how these interactions 'de-humanise' and 're-humanise' the cadaver in this particular setting, this analysis discloses a complex micropolitics in which the conventional distinction between 'living' and 'dead' ignores the multiple ways in which all matter is vitally affective.

The aim of this study is to explore how the dead human body is socially produced through the practices of those involved in teaching anatomy through cadaveric dissection. The perspectives of anatomists learning to teach offer a novel perspective on the existing literature. The study draws on data from interviews with students and teaching staff involved in practical cadaveric dissection during a UK postgraduate anatomy education programme. Interviews addressed participants' experiences, reflections, and emotional responses during practical dissection of donor bodies. Findings address five areas: anticipation and the 'imagined body', ontology and the latent human, detachment, dissociation, and reconciliation, preparation and intentionality, and gratitude and immortalisation. The findings suggest that during the course of practical dissection sessions, anatomists learn to normalise the transgressive activity of human dissection via processes of reconciliation. The transgressive elements are resolved through the agency of the person once living and through a configuration of the anatomist and the donor body in a network of scientific knowledge, pedagogic practice and personal influence.

This study was funded by the UK Medical Research Council (ref G0701604), and managed by the National Institute for Health Research (NIHR-EME 09-800-26) on behalf of the MRC-NIHR partnership, Efficiency and Mechanism Evaluation Programme. The Health Services Research Unit and the Health Economics Research Unit are both funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no role in the study design; collection, analysis, and interpretation of data; the writing of the report; or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily reflect the views of the MRC, National Institute for Health Research, the Department of Health, or the Scottish Government. ; Peer reviewed ; Publisher PDF

This study was funded by the UK Medical Research Council (ref G0701604), and managed by the National Institute for Health Research (NIHR-EME 09-800-26) on behalf of the MRC-NIHR partnership, Efficiency and Mechanism Evaluation Programme. The Health Services Research Unit and the Health Economics Research Unit are both funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. ; Objective To investigate the cost effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. Design Cost effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed up for 36 months and data on health service utilisation and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5 and 10-year time horizon. Setting: 22 hospital eye services in the United Kingdom. Population: Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC). Interventions: Lens extraction compared to standard care (i.e. laser iridotomy followed by medical therapy and glaucoma surgery). Outcome measures: Costs of primary and secondary health care utilisation (UK NHS perspective), quality adjusted life years (QALYs) and the incremental cost effectiveness ratio (ICER) for lens extraction versus standard care. Results: The mean age of participants was 67.5 (8.42), 57.5% were female, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. Mean health service costs were higher in patients randomized to lens extraction: £2,467 versus £1,486. Mean adjusted QALYs were also higher with early lens extraction: 2.602 versus 2.533. The ICER for lens extraction versus standard care was £14,284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7,090 per QALY gained by 5 years, and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions. Conclusions We find that lens extraction has a 67-89% chance of being cost effective at 3 years, and that it may be cost saving by 10 years. ; Publisher PDF ; Peer reviewed

Funding: The project was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 12/35/38). The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no role in considering the study design or in the collection, analysis, or interpretation of data; writing the report; or the decision to submit the article for publication. The views expressed herein are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Acknowledgments Sponsor representative: Pauline Hyman-Taylor (from February 2019), Natalie McGregor (March 2015 to February 2019), Audrey Athlan (from July 2014 to March 2015), Joanne Thornhill (from 2013 to July 2014). Patient and public involvement representative: Rick Walsh, Russel Young. CHaRT Trial Office: Mark Forrest (from 2015), Gladys McPherson (until 2015). CHaRT Trial Office data coordinator: Pauline Garden. Health economists: Eoin Maloney (until 2015), Mehdi Javanbakht (until June 2019).All participants in the trial, staff, and members of the TAGS Investigator Group responsible for recruitment in the clinical centres. ; Peer reviewed ; Publisher PDF

Funding: The project was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 12/35/38). The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. ; Objective : To determine whether primary trabeculectomy or primary medical treatment produces better outcomes in term of quality of life, clinical effectiveness, and safety in patients presenting with advanced glaucoma. Design : Pragmatic multicentre randomised controlled trial. Setting : 27 secondary care glaucoma departments in the UK. Participants : 453 adults presenting with newly diagnosed advanced open angle glaucoma in at least one eye (Hodapp classification) between 3 June 2014 and 31 May 2017. Interventions : Mitomycin C augmented trabeculectomy (n=227) and escalating medical management with intraocular pressure reducing drops (n=226). Main outcome measures : Primary outcome: vision specific quality of life measured with Visual Function Questionnaire-25 (VFQ-25) at 24 months. Secondary outcomes: general health status, glaucoma related quality of life, clinical effectiveness (intraocular pressure, visual field, visual acuity), and safety. Results : At 24 months, the mean VFQ-25 scores in the trabeculectomy and medical arms were 85.4 (SD 13.8) and 84.5 (16.3), respectively (mean difference 1.06, 95% confidence interval −1.32 to 3.43; P=0.38). Mean intraocular pressure was 12.4 (SD 4.7) mm Hg for trabeculectomy and 15.1 (4.8) mm Hg for medical management (mean difference −2.8 (−3.8 to −1.7) mm Hg; P<0.001). Adverse events occurred in 88 (39%) patients in the trabeculectomy arm and 100 (44%) in the medical management arm (relative risk 0.88, 95% confidence interval 0.66 to 1.17; P=0.37). Serious side effects were rare. Conclusion : Primary trabeculectomy had similar quality of life and safety outcomes and achieved a lower intraocular pressure compared with primary medication. ; Publisher PDF ; Peer reviewed

Acknowledgments Special thanks must go to all of the SUSPEND trial participants and staff at each of our recruiting centres for taking part in this trial. We thank our collaborators at the SUSPEND sites, and participating National Health Service (NHS) trusts and boards (NHS Grampian, Plymouth Hospitals NHS Trust, The Newcastle upon Tyne Hospitals NHS Foundation Trust, NHS Highland, South Tees Hospitals NHS Foundation Trust, City Hospitals Sunderland NHS Foundation Trust, The Leeds Teaching Hospitals NHS Trust, North Bristol NHS Trust, University Hospitals Bristol NHS Trust, Norfolk and Norwich University Hospitals NHS Foundation Trust, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, NHS Lothian, Guy's and St Thomas' NHS Foundation Trust, St George's Healthcare NHS Trust, Abertawe Bro Morgannwg University Health Board, Mid Yorkshire Hospitals NHS Trust, South Devon Healthcare NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, Gloucestershire Hospitals NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust, Central Manchester University Hospitals NHS Foundation Trust, Southampton University Hospitals NHS Trust, and The University Hospital of South Manchester NHS Foundation Trust). We thank the staff at the SUSPEND trial office based in the Centre for Healthcare Randomised Trials (CHaRT) within the Health Services Research Unit, University of Aberdeen. This report presents independent research funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, Project Number 08/71/01. The views and opinions expressed in this report are those of the authors and do not necessarily reflect those of the HTA Programme, the NIHR, the NHS, or the Department of Health. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates; however, the opinions expressed in this publication are those of ...