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PubMed1994

Quality of life: sciencing and living the art of human becoming.

Quality of life, from the person's perspective, is the goal of the human becoming theory. Thus far, research on quality of life has been implemented from a totality paradigm perspective, excluding consideration of the human as a unitary being. The most valuable conclusion to be drawn from all the research is that quality of life cannot be quantified. This article specifies a different meaning of quality of life and points out ways of sciencing and living the art of nursing when quality of life is the goal.

Human Development↗

PubMed1994

The impact of social science research on health policy.

The relationship between research and health policy is discussed from a policy process perspective, describing communication problems in the course of policy formulation, implementation and evaluation. Policy process is often expected by researchers to be rational, having logical sequence of steps and the objective evaluation of alternatives based on scientific knowledge. In fact, policies are often formulated without clear problem identification or based on wrong assumption. The timing of research and policy-making differs. Policy-makers need to respond quickly. Evaluations may be regarded by politicians as embarrassing if they point to a need for significant change. It is not satisfactory to consider only research and policy-making: their relationship is influenced by the media, different interest groups and by the general public. Health policy formulation is embedded in the general policy environment of particular societies. Some countries have a long tradition of consensus-building, while in others health reforms have been formulated and introduced in a centralized way. Traditional bio-medical thinking influences health policy-makers. The importance of social and political acceptability tends to be overlooked. The paper emphasizes that we are experiencing an era of scarcity of resources and growing tension concerning allocation decisions. Existing institutions provide insufficient incentives for policy-makers and researchers to promote public dialogue about such issues. The paper concludes that there is a need for new approaches to policy development and implementation, new structures in policy-making, changes in research financing and co-operation between disciplines and new structures for public participation in policy-making. Research should facilitate more open and democratic dialogue about policy options and the consequences of alternative choices.

Communication↗

PubMed2006

Integrating evidence-based practice in the child mental health agency: a template for clinical and organizational change.

This article describes a linked set of activities designed to address the present "science-to-service" gap in evidence-based practice from the perspective of the nonprofit child mental health agency: (a) implementing "systems-of-care" principles; (b) logic modeling; (c) strategic partnerships with external researchers; (d) selective, in-depth program evaluation; (e) critical comparison with a limited number of evidence-based practice models of national significance; and (f) internal and external dissemination activities oriented to evidence-based practice. Implications are drawn both for continuous quality improvement of existing clinical services and for the potential for agencies to contribute high quality, science-based information to child mental health services, singly and through the future development of a national network of experimenting child mental health agencies.

Child↗

PubMed2005

Comparisons of Physicians' and Nurses' Attitudes towards Computers.

Before starting the implementation of integrated hospital information systems, the physicians' and nurses' attitudes towards computers were measured by means of a questionnaire. The study was conducted in Dubrava University Hospital, Zagreb in Croatia. Out of 194 respondents, 141 were nurses and 53 physicians, randomly selected. They surveyed by an anonymous questionnaire consisting of 8 closed questions about demographic data, computer science education and computer usage, and 30 statements on attitudes towards computers. The statements were adapted to a Likert type scale. Differences in attitudes towards computers between groups were compared using Kruskal-Wallis and Mann Whitney test for post-hoc analysis. The total score presented attitudes toward computers. Physicians' total score was 130 (97-144), while nurses' total score was 123 (88-141). It points that the average answer to all statements was between "agree" and "strongly agree", and these high total scores indicated their positive attitudes. Age, computer science education and computer usage were important factors witch enhances the total score. Younger physicians and nurses with computer science education and with previous computer experience had more positive attitudes towards computers than others. Our results are important for planning and implementation of integrated hospital information systems in Croatia.

Attitude of Health Personnel↗

PubMed1996

Basic surgical training. 2: Interactions with the undergraduate medical curriculum.

Proposed changes in postgraduate surgical training must be seen in the context of changes being implemented in medical schools. The reorganization of discipline-based departments into large units of biomedical science; the reduction in time allotted to anatomy, particularly to dissection by students; the development of integrated courses with multidisciplinary examinations in which poor performance in anatomy can be compensated by good marks in other subjects; the decline in staff numbers (faculty) with expertise in human anatomy and corresponding enthusiasm for teaching it; and the loss of demonstratorships available to surgical trainees are all factors that leave today's medical graduates who embark upon surgical training programs poorly equipped in their knowledge of anatomy. This deficiency is not easily remedied by the proposed changes in Basic Surgical Training and is not adequately identified by the examination arrangements. It is argued that a structured oral examination with a wide spectrum of components, including dissections, living and surface anatomy, osteology, radiographs and scans, and microanatomy, would be the best way of assessing the familiarity of candidates with anatomy and their suitability to proceed to Higher Surgical Training.

Anatomy↗

PubMed2002

[Current status of dermatomicrobiology. An overview].

The new German laws dealing with protection against infectious diseases (Infektionsschutzgesetz of 1.1.2001) have reconfirmed the importance of microbiology as a basic science and infectiology as a multi-disciplinary clinical discipline. Concerning dermatological diagnosis and therapy, the implementation of molecular biological techniques has a decisive influence. The discovery of new (e.g. Helicobacter pylori) and the better detection of known organisms (e.g. Chlamydia, Borrelia) suggested findings in questions of causality and therapeutic developments. Concerning the infections of the skin this synopsis provides the state of the art of diagnostic process and treatment in mycology, bacteriology and virology.

Anti-Infective Agents↗

PubMed1996

Learning and Forgetting in Generalized Brain-state-in-a-box (BSB) Neural Associative Memories.

We propose learning and forgetting techniques for the generalized brain-state-in-a-box (BSB) based associative memories. A generalization of the BSB model allows each neuron to have its own bias and the synaptic weight matrix does not have to be symmetric. A pattern is learned by a memory if its noisy or an incomplete version presented to the memory is mapped back to this pattern. A pattern, previously stored, is forgotten or deleted from the memory if a stimulus that is a perturbed version of the pattern, when presented to the memory, is not mapped back to this pattern. In this paper we propose "on-line" memory storage and deletion methods using an iterative method of computing the pseudo-inverse of a given matrix. The proposed methods allow one to "add" or "delete" a memory pattern by updating, rather than recomputing from scratch, the current synaptic weight matrix in a single step. We first analyze the desired characteristics of neural network associative memories. After that, we review the existing methods for design of neural associative memories. Then we discuss the generalized BSB neural model and its possible function as an associative memory and proffer arguments in support of using such models for neural associative memories. In particular, the generalized BSB type models are easier to analyze, synthesize, and implement than other neural networks. The results obtained are illustrated by numerical examples. Copyright 1996 Elsevier Science Ltd

Journal Article↗

PubMed2004

Reflective learning with drama in nursing education--a Swedish attempt to overcome the theory praxis gap.

It is obvious that the gap between theory and praxis in nursing education affects the students' ability to develop understanding and professional knowledge that stems both from theory and practice. Appropriate didactic methods are thus needed in nursing education. In a project we developed and practised a didactic model with the intention of encouraging a reflective attitude within the student, considering caring science in theory as well as in praxis. The didactic model, based on educational drama, was implemented during three terms of the nursing education programme. In this paper we present the educational model and its theoretical foundation. We also present the preliminary outcomes of the project.

Drama↗

PubMed1999

Psychiatric research ethics: an overview of evolving guidelines and current ethical dilemmas in the study of mental illness.

The field of psychiatry has an opportunity to construct a more refined, perhaps more enduring understanding of the ethical basis of mental illness research. The aim of this paper is to help advance this understanding by 1) tracing the evolution of the emerging ethic for biomedical experimentation, including recent recommendations of the President's National Bioethics Advisory Commission, and 2) reviewing data and concepts related to compelling ethical questions now faced in the study of mental disorders. Empirical findings on informed consent, the ethical safeguards of institutional review and surrogate decision making, and the relationship between scientific and ethical imperatives are outlined. Psychiatric researchers will increasingly be called upon to justify their scientific approaches and to seek ways of safeguarding the well-being of people with mental illness who participate in experiments. Most importantly, psychiatric investigators will need to demonstrate their appreciation and respect for ethical dimensions of investigation with special populations. Further empirical study and greater sophistication with respect to the distinct ethical issues in psychiatric research are needed. Although such measures present many challenges, they should not interfere with progress in neuropsychiatric science so long as researchers in our field seek to guide the process of reflection and implementation.

Bioethics↗

PubMed1997

Cardiopulmonary resuscitation: a promise as yet largely unfulfilled.

After failure of initial external defibrillation, restoration of spontaneous circulation is largely contingent on rapid and effective reversal of myocardial ischemia by both mechanical and pharmacologic means. Despite the introduction of modern cardiopulmonary resuscitation (CPR) more than 35 years ago, its universal acceptance, and its wide implementation, no improvements in outcome excepting early defibrillation have been documented over these many years. The science of CPR therefore is still in its infancy. It was incorrectly assumed that all that needs to be known is known and that the need for scientific research was therefore not apparent. Accordingly, serious resuscitation research was neither encouraged nor equitably supported. The ABCs of CPR currently provide for the establishment of a patent airway (A) and intermittent positive pressure ventilation, preferably with oxygen-enriched air (B). These are to be immediately followed with precordial compression (C). This ordering of priorities, however, is based on consensus rather than objective outcome measurements. The ABCs recently have been seriously challenged on the basis of results of both experimental and clinical studies. Conventional external precordial compression restores systemic blood flow. It may be used by both professional and nonprofessional CPR providers, especially bystanders, because of its apparent simplicity and noninvasiveness. However, manual or mechanical external precordial compression typically generates cardiac outputs that represent less than 30% of normal values. Coronary blood flow, which is critical for restoration of spontaneous circulation, is correspondingly reduced. Accordingly, several alternatives to conventional precordial compression have been proposed with the intent of increasing cardiac output and both coronary and cerebral blood flows. Among the large number of pharmaceutical agents initially recommended for cardiac resuscitation, only agents that produce peripheral vasoconstriction are of proved benefit. Epinephrine has been the preferred vasopressor agent for the management of cardiac arrest for more than 35 years because of its alpha-adrenergic effects. However, the potentially adverse effects of epinephrine are related to its beta-adrenergic inotropic actions. The beta-adrenergic actions account for disproportionate increases in myocardial oxygen consumption with increased severity of myocardial ischemic injury and provocation of ectopic ventricular tachycardia and ventricular fibrillation. Nevertheless, epinephrine remains the drug of choice, although adrenergic drugs with selective alpha-adrenergic actions or nonadrenergic vasoconstrictor drugs are likely to emerge as useful alternatives. Experimental and clinical observations have led to identification of continuous monitoring of both end-tidal carbon dioxide and ventricular fibrillation waveforms as practical noninvasive guides because they are highly correlated with both cardiac output and coronary blood flow. Both end-tidal carbon dioxide and ventricular fibrillation waveforms now serve as predictors of the likelihood of successful resuscitation. These two measurements may now be used to guide interventions and especially to assure optimal precordial compression. It is well established that sudden death among adults is predominantly due to malignant ventricular arrhythmias and ventricular fibrillation. Early defibrillation serves as an unequivocally effective immediate intervention. Minimally trained first responders and members of the general public are being enfranchised to use automated external defibrillators for very early defibrillation. Use of these devices by bystanders is the most promising new intervention since CPR was first proposed in the early 1960s. Postresuscitation ventricular dysrhythmias and heart failure are now called postresuscitation myocardial dysfunction. This complication has been recognized as a leading cause of the high postresuscitation mor

Adrenergic alpha-Agonists↗

PubMed1998

Freedom to enjoy learning in the 21st century: developing an active learning culture in nursing.

In 1994, the Wolfson School of Health Sciences was created in Thames Valley University, UK. This paper discusses an active learning approach being implemented throughout the university, and gives an outline of its application within nursing education. Practising as a confident, competent, reflective practitioner in the profession of nursing cannot automatically commence on the day of registration. Rather, the philosophical underpinnings necessary should be fostered throughout the initial nursing education curricula. In a political climate where there is a strong emphasis on efficiency, nurse teachers need to reconsider how the acquisition of nursing knowledge is facilitated. A description of how an active learning approach is being further developed in the nursing skills laboratory and the physiology laboratory is given. An outline identifies how these facilities may help students of nursing to gain knowledge and skills in relation to respiration. The authors recognize that while laboratories have been used widely in general education, their use has been limited in nursing education, particularly in the UK. Informal feedback from students implies that not only do they enjoy learning in these facilities, but also motivation towards learning is raised, an important element in the learning process. It is suggested that this will result ultimately in increased nursing competence. The authors acknowledge that these are preliminary informal findings and that formal investigation is required.

Education, Nursing, Baccalaureate↗

PubMed1999

Relationship between usage of antibiotics in food-producing animals and the appearance of antibiotic resistant bacteria.

Many studies and meeting reports have suggested that the use of some antibiotics in food animals can compromise the treatment of some infectious diseases in humans. Although the studies and reports are timely and important, it is difficult to assess the relative value of the conclusions in relationship to the overall situation concerning antibiotic resistant foodborne bacteria because the data used in the analyses are often of disparate origin. The studies have attempted to establish a cause and effect relationship between the use ('consumption') of antibiotics in food animals and treatment failures in human disease on the basis of [1] antibiotic usage data; [2] in vitro determinations of antibiotic susceptibility of animal and human isolates, [3] results obtained from controlled animal experiments or [4] epidemiological data. Each approach has sought to associate bacterial antibiotic resistance data with it's own immediate focus area of investigation. However, a true assessment of the degree of contribution to human antibiotic resistance problems from animal use can only be facilitated by comprehensively organizing these different approaches into a concerted, coordinated effort. Concurrently, the implementation of a multinational programme aimed at monitoring antibiotic usage in food animals and resistance in specific bacteria associated with those animals should be instituted. In parallel with this endeavour is the implementation of new prudent use guidelines for antibiotic use by veterinarians. Through the use of science-based approaches like these, the development and spread of antibiotic resistant bacteria associated with food animals could be minimized and contained.

Animals↗

PubMed1996

Impact of the Delaney Clause in the EPA.

The U.S. Environmental Protection Agency serves as the lead agency of the Federal government for the regulation of pesticide use in the United States. Regulatory responsibilities are mandated in the Federal Insecticide Fungicide and Rodenticide Act (FIFRA) and several sections of the Federal Food Drug and Cosmetic Act (FFDCA). In order for a pesticide to be used in the U.S., it must either be granted a full registration under Section 3, or offered special consideration under Section 18 or 24 of FIFRA. Tolerances (maximum allowable residue limits) for pesticides to be used on agricultural commodities meant for human consumption or animal feed are established under Sections 408 and/or 409 of FFDCA. This presentation will describe the underlying conflict between Section 409 of FFDCA and both Section 408 and FIFRA, the recommendations made by the National Academy of Sciences in its 1987 publication Regulating Pesticides in Food--The Delaney Paradox, EPA's attempts to implement these recommendations, the true impact of "Delaney" on the ability of EPA to grant tolerances on raw or processed foods for chemicals determined to meet the "induce cancer" criterion and the status of legislation designed to "fix" Delaney.

Carcinogens↗

PubMed1997

Basic Science in Medical Reasoning: An Artificial Intelligence Approach.

A new generation of intelligent systems is growing up in the community of Artificial Intelligence in Medicine. The main goal of these systems is the representation and use of real theory of diseases, as they are represented in medical textbooks or in scientific articles, rather than the heuristic shortcuts of human experts. In this paper, we will argue that the difficulties in the integration of basic science and clinical knowledge in intelligent systems arise from ontological differences between these kinds of knowledge and that the solution can be found in their dynamic integration during the reasoning process. In order to illustrate this point, we will first describe an epistemological analysis of the interplay between basic science knowledge and clinical knowledge, and then we will provide the example of a computational architecture implementing this view.

Journal Article↗

PubMed2003

Evidence-based practice in mental health: practical weaknesses meet political strengths.

UNLABELLED: RATIONALE, AIMS, AND OBJECTIVES: Evidence-based medicine (EBM) has given rise to evidence-based practice (EBP) in the field of mental health. EBP too is predicated on an evidence hierarchy and has the goal of using the "best evidence" (usually randomized controlled trials) to improve practice. EBP is increasingly influential in mental health care in the U.S. Growing numbers of researchers and public officials endorse its claims and pursue its benefits. The rationale for this paper is to examine the potential of EBP for the field of mental health-and public mental health care specifically. Is it likely to contribute to improved lives for mentally ill people? If so, how? METHODS: This qualitative study relies on archival, and to a much lesser extent, informant interview data. Informants were mostly public mental health officials because they are in a position to implement EBP on a large scale and their policies are a matter of public record. Interviews were semi-structured, held in person and on the telephone, and lasted one to two hours. Archival research included the substantial literature on EBM and EBP plus studies and articles on the practice and policy of U.S. public mental health care. RESULTS: The results of this study were that there exists an extensive, coherent literature critical of EBM and of EBP specifically. Attempts to implement EBP will falter on epistemological and organizational barriers. Still, as a public idea--that more science will bring about better mental health practice--EBP may well serve political purposes, especially in the U.S. public mental health system, where more overtly ideological policies have been inadequate in the past. EBP, as a public idea, has the advantage of ambiguity, accountability, quantifiability, etc. CONCLUSIONS: This paper concludes that EBP is growing more influential in public mental health care in the U.S. Its practical strengths, i.e., its improvement of mental health practice, may turn out to be less than its strengths as a public idea in the formulation and dissemination of mental health policy.

Biomedical Research↗

PubMed2002

Dietary interventions in Finland, Norway and Sweden: nutrition policies and strategies.

AIMS: To describe the organization and implementation of nutrition policies, and examine intervention strategies for dietary change in three Scandinavian countries. METHODS: Descriptions of nutrition policies and dietary intervention strategies are based on published nutrition policy research and reports. RESULTS: All countries studied have adopted formal nutrition policies. Norway issued its first white paper in 1976, the Finnish National Nutrition Council published an action plan in 1989, and the Swedish Government issued an official action plan in 1995. Norway has a centralized National Nutrition Council with a permanent administration whereas the responsibilities and administration are more spread out between several authorities and groups in Finland and Sweden. Amongst the dietary intervention strategies employed, a Norwegian nutrition campaign, symbol labelling of foods in Sweden, the community-based North Karelia Project in Finland, and mass catering in Finland and Sweden have been selected as potentially transferable. CONCLUSIONS: Policy documents serve as guidelines for activities and assist in achieving dietary targets. A responsible administrative body with advice from a standing expert committee is valuable for implementation. Guidelines, recommendations or voluntary labelling standards can be incentives to product development and changes to food production. Regional demonstration projects may also encourage action and collaboration.

Finland↗

PubMedDate not supplied

Direct dosing of preweaning rodents in toxicity testing and research: deliberations of an ILSI RSI Expert Working Group.

Laboratory animal studies designed to assess the effects of exposure of a test substance during postnatal development are commonly utilized in basic research and to evaluate potential hazard to children for chemical and pharmaceutical regulation. Direct dosing, defined here as the administration of a test substance directly to a preweaning mammal, has been identified as a useful tool that can be used in the conduct of such studies for regulatory purposes. The International Life Sciences Institute Risk Science Institute (ILSI RSI) convened an Expert Working Group to develop guidance on the design and implementation of direct dosing regulatory studies on preweaning mammals, which was published as an ILSI monograph in 2003 (Zoetis and Walls, Principles and Practices for Direct Dosing of Pre-Weaning Mammals in Toxicity Testing and Research, Washington, DC: ILSI Press, 2003). A summary of the Working Group conclusions regarding direct dosing studies with laboratory rodents are presented here, although the ILSI monograph also includes rabbits, canines, swine and nonhuman primates. Issues to be considered when designing the protocol include selection of the test species, the route of administration, dose levels, and the timing of dosing. Knowledge of the maturational status of the test species and information on critical windows of development are important in creating a valid study design. Most common routes of administration (e.g., oral, inhalation, injection) are possible with typical laboratory species; however, adjustments may be necessary due to practical considerations. Information on the pharmacokinetic profile in young animals versus adults and in the test species versus humans is very useful for determining dosing parameters. The conduct of the study and the interpretation of the data will be improved by an understanding of confounding factors as well as statistical and biological issues specific for postnatal studies. Ultimately, the success of the study will depend upon careful preparation, including thorough training of the technical staff.

Animals↗

PubMed2001

[Care at the Tumor Biology Center Freiburg--on the way].

The concepts of salutogenesis on the one hand and of a management which aims at getting the employees involved into decision-making processes on the other are two core concepts of the Tumor Biology Center, opened in 1993 in Freiburg i.Br., Germany. In this framework nursing--like other health professions--has its own specific task. Nurses with their holistic approach are especially concerned with health promotion. They are involved in various interprofessional teams like the so-called pain conference, the ethics committee, quality circles, and psychological supervision. The Department of Nursing is committed to the scientific orientation of the Tumor Biology Center. Nursing research started right at the opening of the hospital. Today, the most important project is the implementation of nursing diagnosis. National and international conferences are organized to foster the development of nursing science in Germany.

Cancer Care Facilities↗