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PubMed1992

Directions for nursing theory development in the 21st century.

The development of the discipline of nursing has gone through four stages: theorizing, developing a syntax, concept development, and philosophical debate. These stages helped in shaping the characteristics of the discipline as a human science, a practice science, a science with social goals to empower nurses to provide effective and quality care, and one in which gender differences and the need for understanding minorities are areas of primary concern. Further theoretical development in the discipline will be driven by population needs and will be characterized by reaching out to meet the integrative and interdisciplinary nature of these needs. Sources of theories of the future are practice, theory and research. It is anticipated that two models will evolve to guide the development of phenomenon-driven theories in the future and that third generation theorists will utilize these models.

Forecasting↗
PubMed1991

[Naturopathy and alternative medicine--definition of the concept and delineation].

Naturopathic and biological systems of medicine are defined as disciplines that are not directed straight-away against pathological processes as such; their effect is based on stimulating the body's own resources of healing and regulating the dysfunctions that become manifest as disease, using natural active principles as levers to fight disease. Genuine naturopathic systems have mostly been able to prove their science-based efficacy and can be employed successfully especially in chronic diseases and in the after-treatment of severe disease patterns i.e. within the framework of post-disease treatment or rehabilitation. This is contrasted by methods that have not been scientifically proven or acknowledged, i.e. "fringe" systems based on speculative models of thinking, that could not be proven as being clinically effective. These methods cannot be equated with those of naturopathy. German private sickness insurance companies exclude from payment all methods of examination and treatment that are not scientifically recognised, but the German state-managed sickness insurance system provides for paying a subsidy unless the method in question has been specifically excluded. Attention is drawn to the problems that arise if persons who are entitled to receiving a subsidy take out an additional private insurance to supplement the same.

Complementary Therapies↗
PubMed1966

Some thoughts on interdisciplinary science.

The development of the "new biology" is largely a story of developments in interdisciplinary science. This paper considers a few of these of special interest to the author and active at the University of Rochester; namely, dental research, biophysics, radiation biology, health physics, biomedical engineering, and space biology. Rochester pioneered advanced academic training in radiation biology, a field which, despite some earlier tendencies to become associated with techniques rather than scientific problems, is now clearly a substantive discipline. Using biophysics as an example, the paper points to the futility of trying to define in detail the exact nature of each new "interdisciplinary discipline," yet it also decries the coining of new names without due cause. Health physics and its related field, radiological health, are described as centered on problems of radiation protection and as professional in their overtones. The interrelationships between engineering and bioscience are seen most clearly in biomedical engineering and the growing programs in space biology which require complete cooperation and mutual understanding between engineers and bioscientists for their ultimate success. After presenting some implications for medical libraries, the paper closes with a plea that the developers of new interdisciplinary fields and their powerful tools maintain historical perspective, simplicity of approach, and respect for nature's infinite resourcefulness.

Education, Dental, Graduate↗
PubMed1976

Reform in the United States: its impact on medicine and education for family practice.

The historical concept of reform is useful as an aid to understand the modern rise of family practice education. Beginning about 1890, historians have identified several themes of reform in the United States which have been expressed culturally, politically, and socially. Each of these themes, agrarianism, bureaucratization of the professions, and utopianism, has influenced medicine and medical education--first at the turn of the century in the activities of the AMA in promoting public health and in establishing the natural sciences as a basis for medical education and practice. Since the end of World War II, additional reform themes have become visible which are also influencing medicine. Among these are humanism, consumerism, and the women's movement. It is the author's thesis that the present vitality and future development of family practice as a discipline is more dependent on its capacity and willingness to be identified with these expressions of reform than on its negotiations and compromises within the medical education establishment.

American Medical Association↗
PubMed2001

[On the general basis of naturopathy and complementary medicine].

UNLABELLED: On the General Basis of Naturopathy and Complementary Medicine BACKGROUND: Naturopathy and complementary medicine are discussed controversially in public: On the one hand naturopathy is increasingly accepted by the interested public, on the other hand members of the medical community display a critical or even rejecting attitude towards naturopathy. Clarification of the terminology and methods of medical science as well as of naturopathy is necessary. The goal is not only to reestablish the communication between 'classical medicine' and naturopathy but also to gain impulses for the health care system from a cooperation of both, especially with regard to cost development and the search for new solutions and therapies, for example for 'incurable' diseases. PROCEDURE: Here we describe the different view of naturopathy on humans and their diseases and investigate the current scientific knowledge. Naturopathy often has a different, a 'holistic' basis (anthropology), a different therapeutic approach (pathogenesis, salutogenesis). RESULTS: The understanding of science in today's medicine has its origin in history, therefore it is not only continuously changeable but also in need of change. On the one hand new findings from other scientific disciplines should be embraced, on the other hand especially medical science should react to the acute needs and questions of patients. Naturopathy in theory and in applied medicine proves its efficacy (different validities for different procedures). It is followed by the search for the principle of functioning (extension of science). Starting here, an extended understanding of mankind and nature and new models of disease and therapy can be developed. Also, medical ethics in the sense of naturopathy would demand as a first step the use of agents causing the least possible damage. Only when those agents fail, stronger interventions should be chosen. CONCLUSIONS: Due to the necessary enhancement of scientific evaluation of naturopathy and the development of explanatory models, impulses for better therapy approaches are to be expected. Qualitative (new therapy models) and economic (cost reduction) impulses for the health care system would be the result.

Attitude of Health Personnel↗
PubMed2003

Theory for a gas composition sensor based on acoustic properties.

Sound travelling through a gas propagates at different speeds and its intensity attenuates to different degrees depending upon the composition of the gas. Theoretically, a real-time gaseous composition sensor could be based on measuring the sound speed and the acoustic attenuation. To this end, the speed of sound was modelled using standard relations, and the acoustic attenuation was modelled using the theory for vibrational relaxation of gas molecules. The concept for a gas composition sensor is demonstrated theoretically for nitrogen-methane-water and hydrogen-oxygen-water mixtures. For a three-component gas mixture, the measured sound speed and acoustic attenuation each define separate lines in the composition plane of two of the gases. The intersection of the two lines defines the gas composition. It should also be possible to use the concept for mixtures of more than three components, if the nature of the gas composition is known to some extent.

Acoustics↗
PubMedDate not supplied

Post-genome integrative biology: so that's what they call clinical science.

Medical science is increasingly dominated by slogans, a characteristic reflecting its growing bureaucratic and corporate structure. Chief amongst these slogans is the idea that genomics will transform the public health. I believe this view is mistaken. Using studies of the genetics of skin cancer and the genetics of skin pigmentation, I describe how recent discoveries have contributed to our understanding of these topics and of human evolution. I contrast these discoveries with insights gained from other approaches, particularly those based on clinical studies. The 'IKEA model of medical advance'--you just do the basic science in the laboratory and self-assemble in the clinic--is not only damaging to clinical advance, but reflects a widespread ignorance about the nature of disease and how clinical discovery arises. We need to think more about disease and less about genes; more in the clinic and less in the laboratory.

Animals↗
PubMed1997

Neuroimaging and neuropsychology of the striatum. Bridging basic science and clinical practice.

Neuroimaging and neuropsychology are complementary disciplines that provide powerful means for assessing the structure and function of corticostriatal systems. Findings from four model basal ganglia disorders--OCD, TS, HD, and PD--are reviewed. This survey is intended as a vehicle for illustrating the breadth of current clinical and research applications, as well as the potential for future advances. The perspectives brought by neuroimaging and neuropsychology serve as a natural bridge from the basic neuroscience to the clinical practice articles in this issue.

Cognition Disorders↗
PubMed2002

Lyrical language and nursing discourse: can science be the tool of love?

Lyricism is a quality of discourse expressing intensely personal feeling or emotion. It is historically associated with romanticism, which involves the imagination and emotions, the use of autobiographical material, the exaltation of a common humanity, and an appreciation of nature. The language of a science conveys the meaning, significance, and utility of concepts among scholars, practitioners, and the general public. It is incumbent upon nurses to attempt to represent in our disciplinary language the realities lived by people, that is, to apprehend, describe, and explain the full breadth and diversity of human phenomena, guided by the discipline-wide focus on the wholeness of the human being. The language of objectivistic science cannot do this. Even in contemporary qualitative research there are limitations in achieving such a representation. This column therefore calls for greater attention to lyrical discourse in nursing science and outlines the potential benefits in nursing theory development, research, and practice. Encouragement of lyrical discourse in nursing science is consistent with the contemporary movement toward a dialogical rationality. It is posited that, if the ethos of nursing is rooted in love of humanity, lyrical discourse may be one way for nursing to pursue its mission to serve humankind.

Communication↗
PubMed2001

[The role of behavioral sciences in the Hungarian and international medical education: overview and possibilities].

The unilateral bio-medical approach cannot be effective in the prevention and effective treatment of chronic disorders of great epidemiological significance, because the behavioural risk factors are strongly influenced by psychosocial factors too. After the change of the political system in Hungary the most important step in curriculum development was establishing the institutes of behavioural sciences. However, the share of behavioural sciences nowhere exceeds 3% of the curriculum. Yet it has an important role in bridging the gap between the natural and social sciences. Built on the firm basis of natural sciences, the behavioural sciences complement this foundation with aspects of social sciences which emphasize the psychological needs of the patients as well as the psychosocial determinants of health and diseases. The most significant field of behavioural sciences is medical psychology but according to the latest reports on medical education development communication, medical sociology, medical anthropology and bioethics have become increasingly important disciplines in developing medical competence. These fields are organized into an integrated process, arching over the six years of medical training. The present paper gives an overview of the situation and perspectives of teaching behavioural sciences at medical universities.

Academies and Institutes↗
PubMed1977

Balint reassessed: the doctor, his patient, and the illness: a reappraisal.

Psychoanalytical theories seek to explain human behaviour. I believe that they are not scientific, whereas it appears that Balint thought they were. I suggest instead that they are better regarded as myths and part of an artistic discipline. Whereas most of the problems brought by patients to general practitioners can be understood in scientific terms, others can be understood only in artistic terms.These two terms reflect fundamentally different kinds of problems, and different language must be used to discuss them. Neither the two sets of terms nor the two kinds of problem can be confused without giving rise to error. I argue that Michael Balint came to a false conclusion about the nature of the general practitioner's task, about the way the problems posed by his difficult patients may be identified, and about some of the training doctors should receive.Balint's main contribution remains. He showed us that scientific skills alone are not enough if we are to understand our patients fully. He also showed us how a descriptive science of human behaviour in the consulting room was possible.To these insights must be added new understanding. Popper (1963) has provided us with a clear line of demarcation between science and the rest of our knowledge. This idea suggests that general practitioners should reaffirm the importance to them of the intellectual discipline of science. If they wish their understanding and practice to be comprehensive they must also affirm the importance of the arts. What they must not do is to confuse one with the other.

Education, Medical, Continuing↗
PubMed1980

The challenges of teratology.

Teratology has its origins in the descriptive anatomy of malformed humans. Although the term now has much wider connotations, the first challenge of teratology is to recognise its purpose as a science related to a human problem. The wider connotations inevitably mean the involvement of increasing numbers of disciplines, each with its own language and limitations, but each with a unique contribution to make. The second challenge of teratology is therefore to establish and expand communications between these disciplines. The third challenge is teratogenesis, which requires a rather more profound consideration of the nature of causation than a simple cause-and-effect relationship. At the same time as looking back from consequences to causes, we must look forward from the causes to alternative consequences. The affinity of teratogenesis, carcinogenesis, and mutagenesis constitutes the fourth challenge. The fifth challenge brings us back to humans, and lies in the relationships between scientists working within the field of teratology, and industry, the law, the media, and the public at large.

Abnormalities, Drug-Induced↗
PubMed1986

Wellcome lecture 1986. Ideas towards a general theory of clinical biochemistry.

Clinical biochemistry, as an independent discipline within medical science, has developed its own body of theory and practice, and as such it cannot only be concerned with collecting observations. A simple report (plasma potassium = 5.3 mmol/L) is used as a model to discuss the problems of understanding measured chemical changes in the body in disease, and how these lead towards a general theory. These include the nature of the analysand and the reference base; accuracy and identification of the analyte; how disturbances of the steady state contribute to changes in a static result; the implications of precision; differences between activity, concentration and content; the convention of arithmetical concentration; and the meaning of 'abnormal', and of derived terms such as 'predictive value' and 'decision level'. Clinical biochemists/chemical pathologists, with their understanding of all these and related problems, must act as the necessary bridge between analysts and clinicians.

Chemistry, Clinical↗
PubMed2001

The art and science of clinical knowledge: evidence beyond measures and numbers.

Medical doctors claim that their discipline is founded on scientific knowledge. Yet, although the ideas of evidence based medicine are widely accepted, clinical decisions and methods of patient care are based on much more than just the results of controlled experiments. Clinical knowledge consists of interpretive action and interaction-factors that involve communication, opinions, and experiences. The traditional quantitative research methods represent a confined access to clinical knowing, since they incorporate only questions and phenomena that can be controlled, measured, and counted. The tacit knowing of an experienced practitioner should also be investigated, shared, and contested. Qualitative research methods are strategies for the systematic collection, organisation, and interpretation of textual material obtained from talk or observation, which allow the exploration of social events as experienced by individuals in their natural context. Qualitative inquiry could contribute to a broader understanding of medical science.

Clinical Competence↗
PubMed1998

Prebiotics and synbiotics: concepts and nutritional properties.

The main role of diet is to provide enough nutrients to meet the requirements of a balanced diet, while giving the consumer a feeling of satisfaction and well-being. The most recent knowledge in bioscience supports the hypothesis that diet also controls and modulates various functions in the body, and, in doing so, contributes to the state of good health necessary to reduce the risk of some diseases. It is such an hypothesis which is at the origin both of the concept of 'functional food' and the development of a new scientific discipline of 'functional food science'. In the context of this paper the potential 'functional foods' to be discussed are the prebiotics and the synbiotics. The prebiotics developed so far are the non-digestible oligosaccharides and especially the non-digestible fructans among which chicory fructans play a major role. The chicory fructans are beta (2-1) fructo-oligosaccharides classified as natural food ingredients. They positively affect various physiological functions in such a way that they are already or may, in the future, be classified as functional food ingredients for which claims of functional effects or of disease risk reduction might become authorized. They are classified as prebiotic and have been shown to induce an increase in the number of bifidobacteria in human faecal flora. As part of a synbiotic-type product, they are already bifidogenic at a dose of 2.75 g/d and the effect lasts for at least 7 weeks. The other potential functional effects are on the bioavailability of minerals, but also, and more systemically, on the metabolism of lipids. Potential health benefits may concern reduction of the risk of intestinal infectious diseases, cardiovascular disease, non-insulin-dependent diabetes, obesity, osteoporosis and cancer. However, except for the prebiotic effect, and tentatively the improvement of calcium bioavailability, the evidence to support such effects is still missing in humans though hypotheses already exist to justify nutrition studies.

Bifidobacterium↗
PubMed1992

The role of natural science in the premedical curriculum.

The authors examined the role of natural sciences in entering students' academic preparation for admission to the University of California, Los Angeles (UCLA), School of Medicine by analyzing the college transcripts of 290 students in the classes of 1990 and 1995 to determine the breadth of the students' college course work. In addition, during 1990 the authors surveyed 126 full-time basic science and clinical faculty about their views regarding the optimal requirements for admission. The vast majority of the students' college courses had been in the natural sciences, with no significant change in this finding over the five-year period. Of the faculty surveyed, 97 (77%) responded, stating that the majority of prerequisites should be in the natural sciences; their prerequisites were similar to UCLA's 1991-92 admission requirements. The authors suggest that the persistently narrow focus on the natural sciences as a preparation for medical school may explain the nationwide need to instruct medical students in the humanities, and that perhaps it is time to require non-science courses to broaden the educational backgrounds of entering students.

Adolescent↗
PubMed1997

[Nursing research in Finland from 1950s to the present].

In Finland nursing education and research in universities was established in 1979. Research in nursing, however, was done in some amount even before in other disciplines and in the Institute of Nursing Research. In this article, nursing research during 1958-1995 is described, based on the articles in the Finnish Yearbook of Nursing (1958-1988), in the Journal of Nursing Science (Hoitotiede, 1989-1995) and academic licentiate and doctoral dissertations. The analysis indicates strong growth of nursing research in Finland since 1950s. The content of research is multidimensional. The nature of research is quantitative and descriptive; many of the doctoral dissertations in 1990s are qualitative. The research interest has been mainly the patient. Articles in research methods and concept analysis are rare.

Clinical Nursing Research↗