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PubMed1992

Paradigm shifts: theories, models, and tools.

There are many theories and connected tools that have proven to be particularly effective in influencing paradigm shifts. This article has introduced some of each. References listed are useful sources for detailed information. What seems to be clear is that managers should be explicit about the way they characterize their organization. This influences how one measures organizational effectiveness and the selection and application of theories and tools for creating change. The attempt of this article has been to introduce this as a conceptual framework and point to some practical applications in changing organizational thinking.

Models, Organizational↗

PubMed2006

Paradigm shift in treatment of Wilson's disease: zinc therapy now treatment of choice.

Zinc therapy has replaced penicillamine as first-line therapy for Wilson's disease. New guidelines reflect the paradigm shift in treatment that has occurred in recent years. In the old paradigm, Wilson's disease was seen as genetic disorder associated with the accumulation of copper in the liver and in other organs once the liver had become overloaded with copper. When left untreated, the disease was regarded as uniformly fatal. The old treatment guidelines advised, 'decoppering' with penicillamine because this chelating agent was considered effective in restoring most patients to health. Before the start of treatment, patients were warned that their symptoms could worsen during the first weeks or months of therapy, so as to prevent them from abandoning penicillamine therapy in dismay. In the new paradigm, Wilson's disease is seen as a hereditary disorder associated with copper intoxication. The essence of symptomatic Wilson's disease is poisoning by free copper in the blood, that is, by copper that is not bound to ceruloplasmin. This form of copper is toxic, whereas accumulated copper and copper that is bound to ceruloplasmin or metallothionein is not. The treatment of symptomatic Wilson's disease is no longer aimed at 'decoppering', the removal of accumulated copper, but at the normalization of the free copper concentration in blood, to reverse the copper poisoning. This can be achieved safely and effectively with zinc therapy. Zinc induces metallothionein, a highly effective detoxification protein that binds copper. Oral zinc therapy leads to storage of metallothionein-bound copper in the mucosa of the gut and to the excretion of copper via the stools. New treatment guidelines advise against the use of chelating agents as initial treatment because they may aggravate copper intoxication and cause iatrogenic deterioration.

Administration, Oral↗

PubMed1993

A paradigm shift for ethics committees and case consultation: a modest proposal.

In conclusion, the expert-consultation model of ethics consultation is deeply imbedded in modern health care. The paradigm of consultant as expert rather than as community-enabler shapes the expectations and behaviors of healthcare personnel and institutions. This paradigm has also shaped the early stages of HEC development and ethics case consultation. It is time to shift paradigms and adopt one that derives more from the nature of ethics than from the nature of scientific medicine: the role of HECs should be to enable key professionals to carry out the ethical dimensions of patient care. When the HEC does review cases, it should be with the purpose of improving the institution, not of resolving individual cases. One consequence of this is that there will be more individual case reviews than before, but the function, emphasis, agents and locations will shift substantially. A second consequence is that the HEC will function more as an agent of social change by helping to harness the institution's resources. We judge both of these to be a welcome evolution in healthcare ethics.

Ethical Review↗

PubMed2006

A paradigm shift in the conceptualization of psychological trauma in the 20th century.

The inclusion of posttraumatic stress disorder (PTSD) in DSM-III in 1980 represented a paradigm shift in the conceptualisation of post-trauma illness. Hitherto, a normal psychological reaction to a terrifying event was considered short-term and reversible. Long-term effects, characterized as "traumatic neurosis", were regarded as abnormal. Enduring symptoms were explained in terms of hereditary predisposition, early maladaptive experiences or a pre-existing psychiatric disorder. The event served merely as a trigger to something that existed or was waiting to emerge. Secondary gain, the benefits often but not solely financial that a person derived as a result of being ill, was considered the principal cause of any observed failure to recover. The recognition of PTSD reflected a diversion from the role of the group, in particular the "herd instinct", towards a greater appreciation of the individual's experience. From being the responsibility of the subject, traumatic illness became an external imposition and possibly a universal response to a terrifying and unexpected event. This shift from predisposition to the characteristics of the event itself reduced guilt and blame, while the undermining of secondary gain made it easier to award financial compensation.

Conflict, Psychological↗

PubMed1997

Consumer-focused preadmission testing: a paradigm shift.

The current trend in the health care environment is to redesign the delivery of services to make them customer friendly as opposed to hospital convenient. The paradigm shift meets and exceeds customers, expectations by bringing the points of service to the patient. Preadmission testing is accomplished by specially educated, registered professional nurses, who complete the nursing assessment, laboratory work, electrocardiograms, social and rehabilitative services referrals, and patient teaching in a primary care framework. This redesign results in a cost savings for the institution, increased patient and physician satisfaction, and decreased idle time for patients and staff.

Ambulatory Surgical Procedures↗

PubMed1992

Physiological nursing research in dyspnea: a paradigm shift and a metaparadigm exemplar.

Dyspnea, the primary activity-limiting symptom in chronic obstructive pulmonary disease, is associated with respiratory muscle mechanisms. This leads to a paradigm shift from pulmonary processes to respiratory muscle function. Within the context of an integrative metaparadigm, basic and clinical nursing science are developed: to better understand physiological processes associated with dyspnea as presented in three physiological models of dyspnea, to identify respiratory muscle mechanisms associated with current treatment strategies for dyspnea, to eventuate clinical assessments of exercise endurance, and to generate treatment strategies in the promotion of positive life processes. The basic knowledge developed within this program provides a foundation for the generation of strategies to assess patients, to promote normal functioning of life processes, and to enhance positive coping with responses to illness. Thus, this research program provides a model for the development of substantive physiological and clinical knowledge for nursing practice.

Clinical Nursing Research↗

PubMedDate not supplied

Centralizing physician office functions. A paradigm shift.

Recent trends show that organizations that once thought business office centralization was beneficial are re-thinking their strategies and decentralizing business office functions. This article focuses on the paradigm shift from business office centralization to decentralization and the political factors effecting this shift. It provides actual case summaries to demonstrate what has transpired, and presents an alternative strategy to establishing successful business office functions, a hybrid business office.

Financial Management↗

PubMed2005

Paradigm shifts in radiation biology: their impact on intervention for radiation-induced disease.

New mechanistic cell and molecular studies on the effects of very low doses of radiation have resulted in three major paradigm shifts. First, the observation of bystander effects demonstrated that non-hit cells may respond as well as cells in which energy is deposited. Second, it was thought that gene mutations and chromosome aberrations were the most important early changes that represented the initiation phase of radiation-induced cancer. Now genomic instability that leads to the loss of genetic control appears to play a major role in the development of cancer. Finally, recent studies have demonstrated that radiation-induced changes in gene expression can be demonstrated at very low radiation doses. These changes can result in alterations in response pathways, many of which appear to be involved in protective or adaptive responses. The demonstration that unique genes are up- and down-regulated depending on the radiation type, dose and dose rate suggests that different molecular mechanisms are involved in responses to high and low radiation doses. The ability to alter radiation response by physical and chemical treatments suggests that it may be possible to intervene in the progression of radiation-induced diseases. Such intervention may decrease the cancer risk from radiation exposure. This new research also demonstrates that many nonlinear biological processes have an impact on the induction of cancer and the shape of dose-response functions. Thus, for low-LET radiation delivered at low dose rates, the linear, no-threshold hypothesis is not well supported, but it is adequately conservative in protecting against low-dose radiation risks.

Adaptation, Physiological↗

PubMed1996

Is there a paradigm shift in genetics? Lessons from the study of human diseases.

The flood of genetic data made possible by recent technological advances has led to a number of important changes in our conceptual model, or working "paradigm," of genetics. Among these changes are recognition that (1) most mutations are unique; (2) there are many alleles at every locus, not just two; (3) these alleles have a hierarchical, or cladistic, history-dependent structure and geographic distribution; (3) the genotype-to-phenotype relationship is complex and quantitative, even for single-locus traits; (4) genotype-phenotype relationships often depend on the organization of the genome into linkage groups, gene families, and the like; and (5) genes affecting quantitative traits can be individually identified rather than solely being viewed as a polygenic aggregate, and these genes each have the same characteristics as genes for single-locus phenotypes. The latter provides a profound unifying impact on biology by reconciling long-standing conceptual differences on qualitative vis-a-vis quantitative phenotypes and their relative importance and evolution. Many of the data that have led to these advances have been generated in the study of genes associated with diseases in human populations. The conceptual changes affect all of biology, but are especially important in the human context, because the amount, complexity, and historical dependence of the variation in the human genome have serious societal implications regarding the epistemology of genetic causation and applications in public health. But whether these changes constitute a real "paradigm shift" in genetics, or are merely adjustments in the classical models developed early in this century, is unclear.

Alleles↗

PubMed2002

From molecular to molar: a paradigm shift in behavior analysis.

A paradigm clash is occurring within behavior analysis. In the older paradigm, the molecular view, behavior consists of momentary or discrete responses that constitute instances of classes. Variation in response rate reflects variation in the strength or probability of the response class. The newer paradigm, the molar view, sees behavior as composed of activities that take up varying amounts of time. Whereas the molecular view takes response rate and choice to be "derived" measures and hence abstractions, the molar view takes response rate and choice to be concrete temporally extended behavioral allocations and regards momentary "responses" as abstractions. Research findings that point to variation in tempo, asymmetry in concurrent performance, and paradoxical resistance to change are readily interpretable when seen in the light of reinforcement and stimulus control of extended behavioral allocations or activities. Seen in the light of the ontological distinction between classes and individuals, extended behavioral allocations, like species in evolutionary taxonomy, constitute individuals, entities that change without changing their identity. Seeing allocations as individuals implies that less extended activities constitute parts of larger wholes rather than instances of classes. Both laboratory research and everyday behavior are explained plausibly in the light of concrete extended activities and their nesting. The molecular- view, because it requires discrete responses and contiguous events, relies on hypothetical stimuli and consequences to account for the same phenomena. One may prefer the molar view on grounds of elegance, integrative power, and plausibility.

Animals↗

PubMedDate not supplied

Health promotion in heart failure--a paradigm shift.

For people living with heart failure, levels of health exist along a continuum in correlation with the illness experience. A focus on health promotion rather than only disease or symptom management expands opportunities for self-care and presents an emerging paradigm shift in the care of people with heart failure. Results from 2 studies revealed that few health-promoting behaviors were reported by patients with heart failure until a focused intervention that emphasized health promotion as part of self-care was implemented.

Aged↗

PubMed1996

Core culture: the key to successful paradigm shifts.

The core culture of an organization is a major force to be recognized when trying to implement any type of change. Those changes that do not fit well with an existing culture will be strongly resisted. The very culture that may have to undergo change to survive the many paradigm shifts occurring in health care were the basis for past successes. The ability to recognize the core culture of an organization or unit will provide the manager with valuable information when the plan calls for implementing change.

Humans↗

PubMed2002

Multiple sclerosis as a by-product of the failure to sustain protective autoimmunity: a paradigm shift.

Autoimmune diseases are traditionally viewed as an outcome of a chaotic situation in which an individual's immune system reacts against the body's own proteins. In multiple sclerosis, a disease of the white matter of the central nervous system (CNS), the immune attack is directed against myelin proteins. In this article, the authors propose a paradigm shift in the perception of autoimmune disease. They suggest that an autoimmune disease may be viewed as a by-product of the malfunctioning of a physiological autoimmune response whose purpose is protective. The proposed view is based on observations by their group suggesting that an autoimmune response is the body's own mechanism for coping with CNS damage. According to this view, all individuals are endowed with the potential ability to evoke an autoimmune response to CNS injuries. However, the inherent ability to control this response so that its beneficial effect will be expressed is limited and is correlated with the individual's inherent ability to resist autoimmune disease induction. The same autoimmune T cells are responsible for neuroprotection and for disease development. In patients with CNS trauma or neurodegenerative disorders, it might be possible to gain maximal autoimmune protection and avoid autoimmune disease induction by boosting the immune response, using myelin-associated peptides that are nonpathogenic or antigens that simulate the activities of such peptides. In patients with multiple sclerosis and other neurodegenerative diseases, where the aim is to block the autoimmune disorder while deriving the potential benefit of the autoimmune response, the effect of treatment should be immunomodulatory rather than immunosuppressive. In this article, the authors present a novel concept of protective autoimmunity and propose that autoimmune disease is a by-product of failure to sustain it. They summarize the basic findings that led them to formulate the new concept and offer an explanation for the commonly observed presence of cells and antibodies directed against self-components in healthy individuals. The therapeutic implications of the new concept and their experimental findings are discussed.

Animals↗

PubMedDate not supplied

Challenging the future. Clinical laboratory automation: a paradigm shift.

Compared to other industries, implementation of automation in the health-care arena has been delayed. Changes in reimbursement methods are forcing hospitals and other health-care providers to provide more cost-effective services. Clinical laboratory services are essential to the support of newer medical technologies and therapies such as organ transplantation and chemotherapy. The current paradigm for clinical laboratory operations is based on a mix of batch and random access testing and is dependent on personnel. In this article, a new paradigm based on a factory automation model is described. Mechanisms to support the paradigm shift--including a proposal for the creation of a consortium to jointly fund a development operation--are also explored. A clinical laboratory platform prototype currently under development at the University of Nebraska Medical Center is also described.

Academic Medical Centers↗

PubMed2001

A paradigm shift in brain research.

As late as the 1950s, it was assumed that communication between nerve cells in the brain occurred predominantly, if not entirely, by electrical impulses. A decade later, the theory of chemical transmission, which until then had been thought to occur only in the peripheral nervous system, had gained strong entrance for the central nervous system. This paradigm shift opened up an enormous new perspective in brain research, not least by facilitating the study of brain function by means of chemical tools, which in different ways could modify the chemical signaling between nerve cells. Moreover, such tools sometimes turned out to be useful as therapeutic agents. Thus for the first time, a variety of disorders in the central nervous system could be treated effectively.

Animals↗

PubMed1997

[Paradigm shift in dental care services].

According to new legislation socially insured people born after December 31, 1978 do not get prostheses any longer. This law will accelerate the structural change in German dental care that already started in the early eighties. By this health policy finally gives priority to preventive instead of prosthetic dentistry. Some of the most important implications of this paradigm shift for patients and dentists are discussed.

Adolescent↗

PubMed2003

Solid-phase synthesis: a paradigm shift.

A personal review by the first graduate student of Professor R. Bruce Merrifield of the evolution of solid-phase synthesis and its acceptance by various subsets of the chemistry community. Solid-phase synthesis, as currently practised in the synthesis of biopolymers, combinatorial solid-phase organic chemistry, synthesis of natural products, catalyst selection, chemical ligation and materials development, has proven a paradigm shift for the chemistry community.

Combinatorial Chemistry Techniques↗

PubMed2005

Early detection and intervention in psychosis: an ethical paradigm shift.

This paper will first posit the rationale for intervention before onset, then outline the current usual practice of treating schizophrenia and the determinants of that practice. Recent developments that permit or demand a change in this practice will then be elaborated. The article concludes with an elaboration of the currently known risks and benefits of early intervention research. The ethics of early intervention are undergoing a paradigm shift, a shift that supports early intervention research as being necessary to bring empirical balance to territory that is currently overpopulated with zealous opinions.

Antipsychotic Agents↗