Feasibility and effectiveness of providing vestibular rehabilitation for dizzy patients in the community.
Since the majority of people with dizziness in the community are never referred for specialist testing and treatment, the purpose of this study was to investigate whether it was desirable and feasible to provide vestibular rehabilitation for this patient population. Demand for therapy was assessed by a survey of 9198 working age people randomly sampled from six general practices. One in 10 respondents reported current, handicapping dizziness, but fewer than 2% of those with dizziness severe enough to merit treatment proved suitable and willing to attend hospital for testing and rehabilitation. Nevertheless, vestibular rehabilitation was clearly beneficial for the 16 patients who completed the therapy programme, as their scores on measures of symptoms, disability, handicap and postural stability improved significantly post-therapy to near-normal levels. We conclude that there is a need for provision of vestibular rehabilitation in primary care for patients with dizziness in the community.
Drawing on participant observation, in-depth interviews, and statistical analysis of administrative data, this article explores the operation of performance management in the Florida Welfare Transition program and its effects on decisions to sanction welfare clients. Unlike most econometric research on welfare sanctions, we approach sanctioning as an organized practice that reflects, not just client characteristics and behaviors, but also organizational needs, routines, values, authority relations, environments, and systems of reward and punishment. Our analysis focuses on the organization of discipline and, in the process, suggests that scholars may misrepresent and misinterpret the incidence of discipline when they fail to account for the dynamic ways that organization and management shape sanctioning patterns.