Empowerment, quality of life and participation in neurological rehabilitation: Empirical study with stroke patients and their relatives

The active role (participation) that patients with chronic conditions are able to achieve has increasingly been recognised as a measure for the effectiveness of prevention- and rehabilitation strategies. An empowerment scale is an especially effective instrument for measuring social participation, and was applied to stroke patients in neurological rehabilitation for the first time. 26 stroke survivors and 26 informal carers, who participated in self-help groups in Lower Austria, were surveyed. The mean age was 63.9 (+/- 10.4) (stroke survivors) and 61.9 (+/- 9.6) years (informal carers). The mean duration of disease was 7.3 (+/- 3.2) years and the mean length of self-help group participation approximately 4 years. Every other stroke survivor and every fifth informal carer had to give up their professional life because of the stroke. Financial burden, reduction of vacations and social activities was found for both groups. Informal carers more frequently reported an increased fear of a relapse and generally of the future. One third of the stroke survivors had insomnia, depression, and nervousness. Reduced mobility, memory impairment, and increased sensitivity to temperature-changes were seen as the largest burdens. In spite of the large overlap in many domains of empowerment- and quality-of-life measures, empowerment measures also seem to reflect aspects of social participation. Therefore, measures of empowerment should be included in long-term outcome measurements following stroke.

Patient-Practitioner-Remedy (PPR) Entanglement, Part 7: a gyroscopic metaphor for the vital force and its use to illustrate some of the empirical laws of homeopathy

BACKGROUND

One of the principle obstacles to homeopathy's general acceptance has been its perceived lack of sound theoretical basis within accepted deterministic bio-medical thought. This impasse might be circumvented if instead, appeal was made to the nondeterministic concepts of the physical sciences, e.g., quantum theory and its notions of entanglement, nonlocality, and uncertainty; Weak Quantum Theory (WQT) and Patient-Practitioner-Remedy (PPR) Entanglement representing two new complementary strands of thought with the potential to create a new theoretical basis for homeopathy.

OBJECTIVE

The goal of this present study was to generate a preliminary mathematical model of the action and reaction of the Vital Force to diseases and remedies within the developing contexts of WQT and PPR Entanglement, based on the metaphor of a hypothetical 'quantized' gyroscope as its physical representation.

METHODS

The physics of gyroscopic motion was combined with the quantum theory describing rotating objects (without some of its imposed limitations, e.g., Planck's constant, in line with the relaxation of some of orthodox quantum theory's axioms as proposed by WQT). Thus, increase or decrease in the rate of spin of the Vital Force's hypothetical gyroscope was described in terms of quantized 'shift operators' constructed mathematically from the known 'complementarity' of a remedy's primary and secondary symptoms, expressed in the notation of complex numbers. Ultimately, this generates a hypothetical 'wave function' for the Vital Force.

RESULTS

This hypothetical 'wave function' has been used to illustrate certain empirical observations of homeopathy and conventional medicine, e.g., the biphasal action of remedies encapsulated in the Arndt-Schulz Law, Wilder's Law of Initial Value, and some of the results of homeopathic provings.

CONCLUSION

This preliminary theoretical analysis suggests that perhaps these less well-known empirical observations should be reinvestigated and, if confirmed, could begin ultimately to provide a much-needed alternative to the doubleblind placebo-controlled trial as a means of investigating and testing the efficacy of homeopathy.

Rooting the tree of knowledge: a response to Henriques' "psychology defined"

Neither science nor culture could exist without a participant-observer and a conceiving human mind. Being-in-the-world, or "Dasein," as Heidegger termed it, is fundamental to any conceptual understanding we have of how things work in the universe. There is no view from nowhere. Psychology is the primordial ground in which the tree of knowledge has its roots.

Empirical support for a treatment program for families of young children with externalizing problems

We evaluated the efficacy of a manualized multimodal treatment program for young externalizing children. Families were assigned randomly to an immediate 12-week parent and child treatment condition (n = 24) or to a delayed-treatment condition (n = 23). Parents had high attendance, high satisfaction with treatment, and increased knowledge of behavior management principles. Relative to the waitlist condition, treatment parents reported statistically and clinically significant reductions in child behavior problems, improved parenting practices (i.e., increased consistency, decreased power assertive techniques), an increased sense of efficacy, and reduced parenting stress. There was a trend toward parents improving their attitudes toward their children. In considering the process of change, we found evidence that improved parenting practices mediated reductions in child behavior problems and that child improvements mediated changes in parent attitudes and stress. Five months following treatment, teachers reported significant improvements in child behaviors, whereas parents reported that reductions in child behavior problems and parenting stress were maintained.

Religion, spirituality and psychiatry: steps towards rapprochement

OBJECTIVES

To consider the claim that there is a fundamental epistemological conflict between religion and psychiatry over what constitutes rational explanation, and what impediment this might be to rapprochement between the two.

CONCLUSIONS

An epistemological gap most certainly exists, but there is a growing acceptance of the importance of religion and spirituality to psychiatry. Rapprochement may best be achieved by increasing psychiatric awareness and knowledge of the issues, and by a willingness to embrace intellectual, cultural and religious pluralism.

Information processing and reasoning with premises that are empirically false: Interference, working memory, and processing speed

In this study, we looked at the contributions of individual differences in susceptibility to interference and working memory to logical reasoning with premises that were empirically false (i.e., not necessarily true). A total of 97 university students were given a sentence completion task for which a subset of stimuli was designed to generate inappropriate semantic activation that interfered with the correct response, a measure of working memory capacity, and a series of logical reasoning tasks with premises that were not always true. The results indicate that susceptibility to interference, as measured by the error rate on the relevant subset of the sentence completion task, and working memory independently account for variation in reasoning performance. The participants who made more errors in the relevant portion of the sentence completion task also showed more empirical intrusions in the deductive reasoning task, even when the effects of working memory were partialed out. Working memory capacity was more clearly related to processes involved in generating uncertainty responses to inferences for which there was no certain conclusion. A comparison of the results of this study with studies of children's reasoning suggests that adults are capable of more selective executive processes than are children. An analysis of latency measures on the sentence completion task indicated that high working memory participants who made no errors on the sentence completion task used a strategy that involved slower processing speed, as compared with participants with similar levels of working memory who did make errors. In contrast, low working memory participants who made no errors on the sentence completion task had relatively shorter reaction times than did comparable participants who did make errors.

Realism in evidence based medicine: interpreting the randomised controlled trial

Realism is emerging as a paradigm for research and explanation in the natural and social sciences. A realist framework is elaborated and applied to the four possible situations that may generate the observations of randomised, controlled trials. It is demonstrated that by using two realist concepts "mechanism" and "context" a number of misinterpretations of such trials from within the dominant empiricist paradigm may be rectified. Evidence based medicine should adopt realism to temper a misleading empiricism, this will involve relegating statistical arguments to their proper subsidiary place and adopting an adequate theory of causation.

Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis

OBJECTIVES

Our primary goal was to evaluate the impact on in-hospital mortality rate of adequate empirical antibiotic therapy, after controlling for confounding variables, in a cohort of patients admitted to the intensive care unit (ICU) with sepsis. The impact of adequate empirical antibiotic therapy on early (<3 days), 28-day, and 60-day mortality rates also was assessed. We determined the risk factors for inadequate empirical antibiotic therapy. DESIGN Prospective cohort study.

SETTING

ICU of a tertiary hospital.

PATIENTS

All the patients meeting criteria for sepsis at admission to the ICU.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Four hundred and six patients were included. Microbiological documentation of sepsis was obtained in 67% of the patients. At ICU admission, sepsis was present in 105 patients (25.9%), severe sepsis in 116 (28.6%), and septic shock in 185 (45.6%). By multivariate analysis, predictors of in-hospital mortality were Sepsis-related Organ Failure Assessment (SOFA) score at ICU admission (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.19-1.40), the increase in SOFA score over the first 3 days in the ICU (OR, 1.40; 95% CI, 1.19-1.65), respiratory failure within the first 24 hrs in the ICU (OR, 3.12; 95% CI, 1.54-6.33), and inadequate empirical antimicrobial therapy in patients with "nonsurgical sepsis" (OR, 8.14; 95% CI, 1.98-33.5), whereas adequate empirical antimicrobial therapy in "surgical sepsis" (OR, 0.37; 95% CI, 0.18-0.77) and urologic sepsis (OR, 0.14; 95% CI, 0.05-0.41) was a protective factor. Regarding early mortality (<3 days), factors associated with fatality were immunosuppression (OR, 4.57; 95% CI, 1.69-13.87), chronic cardiac failure (OR, 9.83; 95% CI, 1.98-48.69) renal failure within the first 24 hrs in the unit (OR, 8.63; 95% CI, 3.31-22.46), and respiratory failure within the first 24 hrs in the ICU (OR, 12.35; 95% CI, 4.50-33.85). Fungal infection (OR, 47.32; 95% CI, 5.56-200.97) and previous antibiotic therapy within the last month (OR, 2.23; 95% CI, 1.1-5.45) were independent variables related to administration of inadequate antibiotic therapy.

CONCLUSIONS

In patients admitted to the ICU for sepsis, the adequacy of initial empirical antimicrobial treatment is crucial in terms of outcome, although early mortality rate was unaffected by the appropriateness of empirical antibiotic therapy.

Psychoanalysis and empirical research

At the beginning of the nineteenth century, the idea of reason began to lose its universal and absolute value, undermining the view of science as a form of objective knowledge that reveals a fundamental reality. These changes have also had an impact on psychoanalysis, leading to a proliferation of theories and the end of a positivistic approach, epitomized by a 'neutral' analyst who knows the contents of the patient's mind. Hermeneutic philosophy provides a tool with which to explore both theoretical multiplicity and the contribution of the analyst's subjectivity to the analytic process. Furthermore, a hermeneutic approach does not have to be hostile to empirical science, but can be integrated with it in a 'scientific-hermeneutic model' in which historical and biological principles are given equal value.

Determination of the frequency of inadequate antibiotic therapy using calculation of indication failure (IF), cumulative indication failure (CIF), and balanced indication failure (BIF)

Because results of pathogen identification are often lacking when antibiotic therapy is initiated, treatment must frequently be instituted on an empirical basis. The type of empirical therapy will depend on the anticipated pathogen spectrum and naturally also on the prevailing resistance patterns. Inadequate antibiotic therapy may not only be associated with increased overall treatment costs, but will also have adverse effects on mortality. The clinician is frequently faced with an overabundant variety of microbiological data and may fail to interpret them correctly. Therefore, the present study has attempted to "translate" the available microbiological resistance data, frequently presented in the form of percentage rates, into concrete patient numbers and thus illustrate the frequency of inadequate antibiotic therapy. For this purpose, "Indication Failure" (IF), "Cumulative Indication Failure" (CIF) and "Balanced Indication Failure" (BIF) have been calculated based on available microbiological data. For the indication "nosocomial pneumonia", calculations of the BIF show that only one out of 67 or one out of 63 patients is inadequately treated with a therapy with cefepime or imipenem, while one out of 25 patients is inadequately treated when using ceftazidime. However, it must be pointed out that these calculations only represent an interpretation of microbiological data and the success of antibiotic therapy will ultimately also depend on parameters such as the pharmacodynamic properties of an antibiotic or on the immunocompetence of the patient treated.

[Factors influencing the course and duration of inpatient child and adolescent psychiatric treatment: between empiricism and clinical reality]

In the last two decades considerable changes influenced the scope of inpatient treatment in child and adolescent psychiatry. Proceeding from a literature review dilemmas between available research data and clinical practice will be pointed out. Proposals will be made to take into account the complex developmental processes, the individuality and the social context by psychic impaired children and adolescents requiring hospitalisation. This could improve the transfer of research findings into the clinical practice. It will be argued against a confusion of economical interests with research findings.

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.

[Patterns of knowledge in nursing and their implications in teaching]

The paper presents nursing as a discipline that is still setting its boundaries and that because of this has the need to define its own form of knowledge and how to produce and validate it. With this in mind, a brief literature review on knowledge patterns which are specific to nursing, as well as empirical, ethical, esthetical and personal patterns are presented. From the characterization of each one of these patterns, its implication in teaching is discussed, highlighting the need to privilege those forms of knowledge during the process of formal teaching-learning.

Fuzzy logic and nursing

In empiricism, there are only two answers for a question: black or white. Yet, subjective meanings of human behaviours and responses toward health and illness cannot be simply explained with black and white. Gray zones are needed because they are characterized by complexity and require a contextual understanding. In this paper, we present and suggest fuzzy logic as an example of theoretical bases that help transcend the conflicts between objectivity and subjectivity, respect gray zones between black and white answers for questions, and provide a contextual understanding of complex nursing phenomenon. A historical review of fuzzy logic is followed by a definition of fuzzy logic. Then, fuzzy logic is discussed in terms of its compatibility with nursing epistemological views and philosophical thoughts. Fuzzy logic agrees with three categories of epistemological views of nursing, including correspondence, coherence and pragmatism. Fuzzy logic also agrees with four major philosophical thoughts in nursing, including postempiricism, pragmatism, feminism, and postmodernism. Based on the discussion, we propose that fuzzy logic be further explored, used and developed in research and practice in the nursing areas/situations/phenomena that are characterized by complexity, ambiguousness, and vagueness.

Poststructuralist musings on the mind/body question in health care

Consideration of mind/body phenomena in health care has been grounded in the constraints of overt and covert paradigmatic assumptions and the mechanisms of power/knowledge that poststructuralists pose as characteristic of empiricism. This article examines the development and conceptualization of mind/body phenomena within the context of evidence considered fitting in health care, that is, within the disciplinary matrix of empiricism. Discussion focuses particularly on inference, probability, and cause and effect, significant components of empiricism, as they have influenced the direction of the mind/body debate in health care during the 20th and early 21st centuries. A focus on disciplinary structure and rules of force subtly grounding empiricism may be the best we have for grasping the place of a phenomenon like mind/body within nursing and the health care disciplines, if such grasping is warranted at all.

[Research on violence against women in Latin America: from blind empiricism to theory without data]

Research on violence against women in Latin America presents an interesting paradox: while the number of studies is quite small, there also appears to be a sense that research on this topic has been exhausted, despite the lack of any definitive responses to the nature and causes of the problem. This results from the boom in studies with a strong empirical focus, lacking any basis in more general sociological theory. On the other hand, research using social theory tends to ignore the existing mediations between structural arrangements and any individual specific behavior, as well as the interactive nature of domestic violence. Meanwhile, empirical research presents inconsistent results and tends to run into methodological problems such as operational confusion, contradictory findings, and results and recommendations that are too obvious. New research designs must be developed to enrich the field and which are solidly based on the body of conceptual knowledge in social sciences, abandoning designs without theory and those which are merely statistical. Only then will it be possible to imagine the new research questions that the problem of violence requires.

Fairness heuristic theory: valid but not empirical

Fairness heuristic theory is concerned with how people react to outcomes of their dealings with authorities, and makes some predictions concerning the relationship between perceived fairness of procedures, perceived fairness of outcomes and acceptance of outcomes. Although considerable effort has been put into establishing empirical evidence for the theory, it is argued that such efforts have no bearing upon the truth of the theory. Central propositions of fairness heuristic theory that have recently been tested empirically are examined and found to be nonempirical and noncontingent. The propositions, it is argued, are necessary truths of commonsense psychology that are not falsifiable by empirical outcomes. Hence, empirical research designed to test them, it is argued, is fruitless and misguided.

The nativist-empiricist controversy in the context of recent research on spatial and quantitative development

Demonstrations of cognitive competence in preschool children and infants played an important role in the waning influence of Piagetian theory and the rise of nativism. Arguments and data favoring modularity have further buttressed the casefor nativism. This article reviews evidence concerning early competence and modularity in the spatial and quantitative domains, as well as the role of experience in development. This evidence provides little reason to support nativist claims in either domain.