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PubMed2003

Expanding the use of empiricism in nursing: can we bridge the gap between knowledge and clinical practice?

The philosophy of Aristotle and its impact on the process of empirical scientific inquiry has been substantial. The influence of the clarity and orderliness of his thinking, when applied to the acquisition of knowledge in nursing, can not be overstated. Traditional empirical approaches have and will continue to have an important influence on the development of nursing knowledge through nursing research. However, as nursing is primarily a practice discipline, the transition from empirical and syllogistic reasoning is problematic. Other types of inquiry are essential in the application of nursing knowledge obtained by empirical scientific approaches and to understand how that knowledge can best be used in the care of patients. This paper reviews the strengths and limitations of syllogistic reasoning by applying it to a recently published study on temperature measurement in nursing. It then discusses possible ways that the empirical knowledge gained from that study and confirmed in its reasoning by logical analysis could be used in the daily care of critically ill patients. It concludes by highlighting the utility of broader approaches to knowledge development, including interpretative approaches and contemporary empiricism, as a way to bridge the gap between factual empirical knowledge and the practical application of that knowledge in everyday clinical nursing practice.

Critical Care↗

PubMed2005

Evolution in heterogeneous environments and the potential of maintenance of genetic variation in traits of adaptive significance.

The maintenance of genetic variation in traits of adaptive significance has been a major dilemma of evolutionary biology. Considering the pattern of increased genetic variation associated with environmental clines and heterogeneous environments, selection in heterogeneous environments has been proposed to facilitate the maintenance of genetic variation. Some models examining whether genetic variation can be maintained, in heterogeneous environments are reviewed. Genetic mechanisms that constrain evolution in quantitative genetic traits indicate that genetic variation can be maintained but when is not clear. Furthermore, no comprehensive models have been developed, likely due to the genetic and environmental complexity of this issue. Therefore, I have suggested two empirical approaches to provide insight for future theoretical and empirical research. Traditional path analysis has been a very powerful approach for understanding phenotypic selection. However, it requires substantial information on the biology of the study system to construct a causal model and alternatives. Exploratory path analysis is a data driven approach that uses the statistical relationships in the data to construct a set of models. For example, it can be used for understanding phenotypic selection in different environments, where there is no prior information to develop path models in the different environments. Data from Brassica rapa grown in different nutrients indicated that selection changed in the different environments. Experimental evolutionary studies will provide direct tests as to when genetic variation is maintained.

Adaptation, Biological↗

PubMed1984

Molecular lesions in cancer.

Newer methods of identifying biochemical events associated with cancer include recombinant DNA technology, monoclonal antibodies and improved analysis of nuclear and other cell functions to determine specific events which occur commonly in cancer cells. 'Onc-gene' products offer potential opportunities for new approaches to cancer treatment and the hope of inducing differentiation of cancer cells toward their normal counterparts. Studies on antigens which react with monoclonal antibodies offer the opportunity for 'epitope attack' which may be effected by improved drugs or by design of totally new drugs to bind to specific reactive sites. The complexity and pleiomorphism of cancer do not permit predictions as to whether these approaches will be more effective than the empirical approach to cancer treatment.

Animals↗

PubMed2001

Problems with the sickness impact profile: a theoretically based analysis and a proposal for a new method of implementation and scoring.

The Sickness Impact Profile (SIP) is one of the most widely used health status measures, but there are problems with the measure that lead to inconsistent and illogical scores. There are many desirable features to the SIP development methodology in that it is based on a good range of items and the item weightings are valuable. The current method of scoring the SIP is the use of a summated total and was selected based on limited empirical evidence. However, in this paper we argue that there are problems with the SIP because the current empirically derived method of scoring is incompatible with both the underlying theoretical scaling framework (Thurstone scaling) and the nature of the items in the SIP. In addition, the items do not have properties consistent with the scaling methodology. We suggest that it is crucial to take both a theoretical and empirical approach to selecting a scoring method. To examine problems associated with the SIP we explored the underlying scaling methodology and identified the types of items in the SIP. A new method of scoring is proposed that is consistent with the items and scaling in the SIP, namely using the maximum individual weighting from the items that were checked as a category score. This new method of scoring resolves many of the previously observed problems in the SIP. The new method of scoring also presented the opportunity for a new implementation of the SIP that reduces the number of items that most respondents, especially those with severe limitations, would be asked. Without taking a theoretical approach to scoring we suggest that subsequent, empirically based, scale amendments are unlikely to solve the problems. It is proposed that this new method of scoring justifies a thorough empirical investigation.

Activities of Daily Living↗

PubMed2003

Gender in medical ethics: re-examining the conceptual basis of empirical research.

Conducting empirical research on gender in medical ethics is a challenge from a theoretical as well as a practical point of view. It still has to be clarified how gender aspects can be integrated without sustaining gender stereotypes. The developmental psychologist Carol Gilligan was among the first to question ethics from a gendered point of view. The notion of care introduced by her challenged conventional developmental psychology as well as moral philosophy. Gilligan was criticised, however, because her concept of 'two different voices' may reinforce gender stereotypes. Moreover, although Gilligan stressed relatedness, this is not reflected in her own empirical approach, which still focuses on individual moral reflection. Concepts from social psychology can help overcome both problems. Social categories like gender shape moral identity and moral decisions. If morality is understood as being lived through actions of persons in social relationships, gender becomes a helpful category of moral analysis. Our findings will provide a conceptual basis for the question how empirical research in medical ethics can successfully embrace a gendered perspective.

Cognition↗

PubMed2002

A phenomenological account of users' experiences of assertive community treatment.

Assertive community treatment (ACT) is a widely propagated team approach to community mental health care that 'assertively' engages a subgroup of individuals with severe mental illness who continuously disengage from mental health services. It involves a number of interested parties--including clients, carers, clinicians and managers. Each operates according to perceived ethical principles related to their values, mores and principles. ACT condenses a dilemma that is common in psychiatry. ACT proffers social control whilst simultaneously holding therapeutic aspiration. The clients' perspective of this dilemma was studied in interviews with 12 clients using the 'grounded theory' approach. Results suggest that clients' disengagement is as much a historical and cultural phenomenon as a result of lack of insight. Many clients had experienced rejection of early help-seeking behaviour and all had been subject to coercive interventions. These coercive interventions were experienced as an attack on identity. All felt that their voice had not been listened to in previous interactions with psychiatric services. Consequentially the clients had an increased level of arousal around issues of power, which needs to be incorporated when examining the ethics of community psychiatry. Traditional notions of the difference between persuasion and coercion--for example--may need to be adapted for this client group. Results are compared with the provider perspective. We conclude that the perspectives differ on two key dimensions. Such an empirical approach to examining psychiatric ethics may ensure that we incorporate the subjectivities of various interested parties in the clinical decision-making process.

Adult↗

PubMed2005

Hope and the ethics of disclosure for terminally ill cancer patients.

Cancer diagnosis presents a disclosure dilemma for physicians, holding in tension the physician's obligation to provide diagnosis and its impact on the patient. To address this dilemma the traditional approach of physicians, typified as the psychological-empirical approach to hope, needs to be complemented by a patient-oriented approach, described as the phenomenological hermeneutics of hope.

Emotions↗

PubMed1999

Genetically derived toxoids for use as vaccines and adjuvants.

Until very recently, development of vaccines has been based on an empirical approach. For example, bacterial toxins have been detoxified using empirical chemical treatment. Progress in biotechnology and molecular biology has allowed the fine knowledge of the structure-function relationship of several bacterial toxins. Thanks to this, the genetic attenuation of bacterial toxins has been made possible. Following this approach, a genetically detoxified pertussis toxin has been produced. This molecule is now the component of an acellular pertussis vaccine, which has been shown to be highly immunogenic and efficacious in infants. The same strategy of molecular detoxification of bacterial toxins has been applied to cholera toxin and to the Escherichia coli heat-labile enterotoxin. Toxin mutants devoid of any toxic activity have been produced and shown in animals to be highly immunogenic and to exhibit strong adjuvanticity when administered at mucosal sites in conjunction with several antigens. These successful results show that rational design of stronger and safer vaccines is feasible.

Adjuvants, Immunologic↗

PubMed1998

Intergroup relations: insights from a theoretically integrative approach.

In social psychology, specific research traditions, which often spring up in response to external events or social problems, tend to perpetuate the theoretical assumptions and methodological approaches with which they began. As a result, theories and methods that have proven powerful in 1 topic area are often not applied in other areas, even to conceptually similar issues. The authors adopt a theoretically integrative approach to the topic of intergroup relations. Theories and empirical approaches from the domains of attitudes, impression formation, the self, personal relationships, and norms offer many new insights into problematic issues, such as repeated findings of dissociations among stereotyping, prejudice, and discrimination. This integrative approach not only promises new theoretical advances, but also suggests numerous potential practical approaches to limiting or reducing destructive patterns of intergroup relations.

Humans↗

PubMed1996

Measuring defensive medicine using clinical scenario surveys.

For more than two decades, advocates of malpractice system reform have claimed that the most damaging and costly result of the U.S. medical malpractice system is the practice of defensive medicine, in which physicians order tests and procedures primarily because of fear of malpractice liability. In this article, we discuss the issues raised by different definitions of defensive medicine and propose a working definition to guide measurement of the concept. We also consider the strengths and weaknesses of available approaches for measuring defensive medicine. Finally, we describe an empirical approach to measuring defensive medicine using clinical scenario surveys. The results suggest that, if physicians actually practice as they say they would in these surveys, defensive medicine does exist, although not to the extent suggested by anecdotal evidence or direct physician surveys. The results also suggest that defensive medicine varies considerably across clinical situations. In all of the scenarios, many physicians chose aggressive patient management styles even though conservative management was considered medically acceptable by the expert panels that developed the scenarios. In most cases, medical indications, not malpractice concerns, motivated clinical choices. Our results highlight the limitations of surveys as a method of measuring the extent of defensive medicine. The implications of managed care and health care reform for defensive medicine are also discussed.

Attitude of Health Personnel↗

PubMed2004

Further thoughts on an experiential psychoanalytic approach to the Rorschach.

On the basis of the work of Schachtel and Mayman, the author previously outlined an experiential approach to the Rorschach that differed from both an empirical approach and a more classic psychoanalytic approach originally proposed by Rapaport. Herein, the author further describes that approach by focusing on the person of the assessor as he or she goes about interpreting a protocol. Borrowing from the treatment literature, the author discusses the processes involved, including the need to immerse oneself in the raw data, the internal split between the experiencing self and the observing self, and the role of empathy and reflection.

Attitude↗

PubMed1986

The causes of international labor migrations--a demand-determined approach.

The author first studies the reasons why people migrate using a neoclassical approach concerning income differentials. He tests this approach empirically and demonstrates its limits. A demand-determination approach based on human capital theory is then outlined to overcome these limits and to take into account restrictive immigration controls. Migration from Italy, Spain, Greece, Portugal, and Turkey to the European Community destination countries is examined. It is concluded that "the demand for immigrants in the destination country is the decisive condition for the phenomenon of international labor migration, and the supply of migration-willing workers is only a necessary condition."

Asia↗

PubMedDate not supplied

[Semiology and nosology].

While distinguishing three successive steps in the making of a diagnosis, the authors point out the premises of modern semiology. They refer to the work of K. Schneider (pragmatic approach), Jaspers, Bleuler and Janzarik (approach based on theoretical concepts), Kasanin and finally Langfeldt (empirical approach). Current approaches of semiology try to define diagnostic criteria. In that line of thinking, the school of Vienna, while establishing the insufficiency of all systems, proposes the adoption of a polydiagnostic approach that would eventually define consistent semiologies that refer with certainty to real nosological entities.

Bipolar Disorder↗

PubMed2002

Theoretical, empirical and practical approaches to resolving the unmet information needs of clinical information system users.

We hypothesize that when clinicians review clinical data in an electronic medical record, the information needs that arise are predictable, based on a number of situational factors. Because our theory does not say, exactly, what those needs are, we are using an empirical approach (observation) to detecting and categorizing them. For each need, we can construct an "infobutton" that links the clinical data to an on-line information resource. We have constructed an Infobutton Manager to match the data being reviewed by clinicians with context-appropriate infobuttons. This paper describes how the theory, observations, and practical solutions can come together to improve clinician decision making by resolving information needs.

Decision Making, Computer-Assisted↗

PubMedDate not supplied

Optimising cryopreservation protocols for haematopoietic progenitor cells: a methodological approach for umbilical cord blood.

Current cryopreservation protocols for haematopoietic cells have developed largely empirically and there is no consensus on an optimal method of preservation. These protocols, though providing sufficient cells to permit engraftment, can lead to cell loss of the order of 50 percent. In the context of umbilical cord blood such losses are unacceptable. Whilst an empirical approach can provide an acceptable level of recovery, the cryopreservation process can only be optimised by adopting a methodological approach. This paper provides an overview of just such an approach as illustrated by a study on CD34 cells from umbilical cord blood. It involves firstly the determination of membrane permeability parameters that can then be used to model safe addition and elution protocols for the chosen cryoprotectant, in this case dimethyl sulphoxide. This in turn permits cryoprotectant toxicity to be evaluated free from the confounding effect of osmotic damage caused by inappropriate addition and elution protocols. Finally, non-toxic concentrations of cryoprotectant may be investigated in a cooling rate study to provide an optimal cryopreservation protocol. Using the model, the effect on CD34 cells of current addition and elution protocols was also examined.

Antigens, CD34↗

PubMed2003

Treatment of pruritus associated with systemic disorders in the elderly: a review of the role of new therapies.

Generalised pruritus is common in the elderly. Idiopathic 'senile pruritus' is a diagnosis of exclusion, and an underlying systemic disorder should be sought. Thyroid disease, haematological malignancy, iron deficiency, cholestasis or renal impairment may be responsible for pruritus. Rarely pruritus may occur after cerebral infarction or as a paraneoplastic phenomenon. The mechanisms of pruritus are poorly understood. In systemic disorders, correction of the underlying disorder alleviates itch. However, when this cannot be achieved, a symptomatic approach is required. Response to treatment varies enormously and an empirical approach is often required. Topical applications are available to soothe the skin and bandaging techniques may improve their efficacy. A number of more targeted treatments are available for renal and cholestatic pruritus. Novel therapies such as thalidomide, opioid antagonists, ondansetron and phototherapy with ultraviolet (UV)-B radiation are now being used. Treatment of pruritus needs to be individualised, and the elderly present a particular challenge. Adequate delivery of simple emollients may be impossible because of physical impairment The elderly are more vulnerable to the adverse effects of treatments, comorbidities may alter the pharmacokinetics of drug metabolism and polypharmacy increases the likelihood of adverse drug interactions. Cognitive impairment can lead to poor compliance with treatment. The patient's general health, the severity of symptoms and the adverse effects of treatment all need to be considered. Most treatments are of benefit only to some patients; others derive only marginal improvement. Many of the newer treatments are unlicensed for pruritus and should preferably be administered under specialist supervision. We review the literature concerning the treatment of itch associated with systemic diseases, with particular emphasis on issues relevant to the elderly. Pruritus is a difficult symptom to treat. However, it is hoped that research into the mechanisms underlying the pruritus of systemic disease will allow a better understanding so that we should be able to look forward to more specific and effective therapies in the future.

Aged↗

PubMed2000

What might the psychobiology of posttraumatic stress disorder teach us about future approaches to pharmacotherapy?

This review considers future directions for developing effective drugs for posttraumatic stress disorder (PTSD). At present, we have embarked upon an empirical approach in which pharmacologic research consists of clinical trials with agents, such as antidepressants, anxiolytics, and anticonvulsants, initially developed for different purposes. The approach taken here is theoretical rather than empirical, starting with what is known about the unique pathophysiology of PTSD and then predicting the types of pharmacologic agents that might prove effective in the future. Such classes of compounds include corticotropin-releasing factor antagonists, neuropeptide Y enhancers, antiadrenergic compounds, drugs to down-regulate glucocorticoid receptors, more specific serotonergic agents, agents normalizing opioid function, substance P antagonists, N-methyl-D-aspartate facilitators, and antikindling/antisensitization anticonvulsants.

Corticotropin-Releasing Hormone↗

PubMed1994

Determining confidence intervals for parameters derived from analysis of equilibrium analytical ultracentrifugation data.

In the above discussion, we have introduced the profiling approach of Bates and Watts. It is an easy to implement, empirical approach to the determination of confidence intervals for parameters in nonlinear models. We have applied the approach to the analysis of equilibrium sedimentation data and have demonstrated that, although models for analyzing such data are formally nonlinear they are functionally linear. As such, linear approximation confidence intervals for the parameters are adequate for these models and data sets. Further, we have been able to examine the effect of implementing a multiple independent variable approach (in this case, using multiple rotor speeds) on the precision of the analysis. We found that the standard errors of the parameters were reduced and that this is accounted for by either the increase in the number of data points or the decreases in parameter correlation. In this case, profiling helped to visualize the effect on the sum of squares surface of reducing parameter correlation, making the effect of the small decreases in the correlation of some parameters more evident. Using profiling, it should be easy to explore other methods for the improvement of the analysis of ultracentrifugation data and to be able to quantitate the improvement. With the above discussion as an example, it is likely that the profiling approach should be quite useful and broadly applicable in the analysis of data in terms of nonlinear models.

Computer Simulation↗