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PubMed2006

Law and emotion: a proposed taxonomy of an emerging field.

Scholars from diverse fields have begun to study the intersection of emotion and law. The notion that reason and emotion are cleanly separable--and that law rightly privileges and admits only of the former--is deeply engrained. Law and emotion scholarship proceeds instead from the belief that the legal relevance of emotion is both significant and deserving of (and amenable to) close scrutiny. It is organized around six approaches, each of which is defined and discussed: emotion-centered, emotional phenomenon, emotion theory, legal doctrine, theory of law; and legal actor. Drawing on the analytic value of the proposed taxonomy, any exploration of law and emotion should strive to identify which emotion(s) it takes as its focus; distinguish implicated emotion-driven phenomena; explore relevant and competing theories of the emotions; limit itself to a particular type of legal doctrine; expose underlying theories of law; and make clear which legal actors are implicated. Directions for future research are discussed and cross-disciplinary collaboration encouraged.

Classification↗
PubMed2004

What must we mean by "community"? A processive account.

The term "community" in ethics and bioethics traditionally has been used to designate either a specific kind of moral relationship available to rational agents or, in contrast, the context in which any sense of rational agency can even be understood. I argue that bioethics is better served when both "selves" and "community" are expressed through a more processive language that highlights the functional character of such concepts. In particular, I see the turn to "processive" community in bioethics as a turn towards method, contextualization, and narrative. In clinical practice, such a processive account demands that bioethics concentrate on methods of developing healthy dialogue and deeper understanding from within the problematic situation rather than trying to "fix" problems using ethical tools developed from outside the present situation. "Community," I argue, is in and of the interactive processes of inquiry itself. Such inquiry, such "communitying," requires that we engage individual patients in context; it demands more than simply gaining their permission or mere consent; it demands developing a supportive environment for participation.

Bioethical Issues↗
PubMed2005

Foundations of interdisciplinarity: a Lonergan perspective.

The postmodern enterprise, with its foundationlessness, fragmentariness, constructivism, and neopragmatism challenges interdisciplinarity. This paper discusses functional specialization and interdisciplinary method which provides a basis for interdisciplinary collaboration. In functional specialization, successive stages in the process of coming to know are distinguished. These stages correspond to Lonergan's four levels of consciousness, namely experiencing the data, coming to understanding through addressing questions which arise from the data, and judgment about which hypothesis best fits the data. Authenticity, which involves genuine attentiveness, intelligence, reasonableness, and responsibility, guides the appropriate attitude in interdisciplinary work.

Awareness↗
PubMed2006

Drug-related problems in general practice: results from a development project in Denmark.

OBJECTIVE: The objective of the study is identify and document drug-related problems and other possible quality problems in primary care through a pharmacist-run medication review and screening service. GPs' acceptance and implementation rates of the pharmacist's recommendations are evaluated. METHOD: A community pharmacist worked 20 h per week for 18 months in a GP practice with three GPs. RESULTS: The pharmacist completed 40 reviews and identified 103 drug-related problems. GPs had a high rate of acceptance of the pharmacist's suggested interventions (83%), and 77% of the recommendations had been implemented. 765 (12.5%) possible quality problems were identified after screening 6094 medical records. The physicians accepted 86% of the recommendations to initiate low dosage ASA and treatment was implemented for 63% of the patients. 76% of the recommendations to initiate Statin treatment were agreed on and 56% were implemented. CONCLUSIONS: The pharmacist was able to identify drug-related problems and other possible quality problems with regard to quality assurance of individual patient's drug treatment. The GPs accepted and implemented the pharmacist's recommendations. It was feasible to implement the services and to establish well-functioning co-operation between the pharmacist and the GPs.

Aged↗
PubMed2006

Anemia, chronic renal disease and congestive heart failure--the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists.

Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy and progress to end stage CHF with many hospitalizations, poor quality of life (QoL), progressive chronic kidney disease (CKD) which can lead to end stage kidney disease (ESKD), or die of cardiovascular complications within a short time. One factor that has generally been ignored in many of these people is the fact that they are often anemic. The anemia in CHF is due mainly to the frequently-associated CKD but also to the inhibitory effects of cytokines on erythropoietin production and on bone marrow activity, as well as to their interference with iron absorption from the gut and their inhibiting effect on the release of iron from iron stores. Anemia itself may further worsen cardiac and renal function and make the patients resistant to standard CHF therapy. Indeed anemia in CHF has been associated with increased severity of CHF, increased hospitalization, worse cardiac function and functional class, the need for higher doses of diuretics, progressive worsening of renal function and reduced QoL. In both controlled and uncontrolled studies of CHF, the correction of the anemia with erythropoietin (EPO) and oral or intravenous (IV) iron has been associated with improvement in many cardiac and renal parameters and an increased QoL. EPO itself may also play a direct role in improving the heart unrelated to the improvement of the anemia--by reducing apoptosis of cardiac and endothelial cells, increasing the number of endothelial progenitor cells, and improving endothelial cell function and neovascularization of the heart. Anemia may also play a role in the worsening of acute myocardial infarction and chronic coronary heart disease (CHD) and in the cardiovascular complications of renal transplantation. Anemia, CHF and CKD interact as a vicious circle so as to cause or worsen each other- the so-called cardio renal anemia syndrome. Only adequate treatment of all three conditions can prevent the CHF and CKD from progressing.

Anemia↗
PubMed2007

The sociobiologic integrative model (SBIM): enhancing the integration of sociobehavioral, environmental, and biomolecular knowledge in urban health and disparities research.

Disentangling the myriad determinants of disease, within the context of urban health or health disparities, requires a transdisciplinary approach. Transdisciplinary approaches draw on concepts from multiple scientific disciplines to develop a novel, integrated perspective from which to conduct scientific investigation. Most historic and contemporary conceptual models of health were derived either from the sociobehavioral sciences or the biomolecular sciences. Those models deriving from the sociobehavioral sciences generally lack detail on involved biological mechanisms whereas those derived from the biomolecular sciences largely do not consider socioenvironmental determinants. As such, advances in transdisciplinary characterizations of health in complex systems like the urban environment or health disparities may be impeded. This paper suggests a sociobiologic organizing model that encourages a multilevel, integrative perspective in the study of urban health and health disparities.

Causality↗
PubMed2006

Evolving trends in medical care-coordination for patients with HIV and AIDS.

HIV/AIDS is a condition characterized by a variety of medical and social needs that affect individuals over time. System-level problems of access, rising costs of care, and varying quality of HIV/AIDS care in addition to the individual barriers to care such as stigma, perceived discrimination, competing needs, and co-morbid conditions have highlighted the importance of using comprehensive approaches to care delivery. Several types of services have been proposed to improve care coordination for various diseases, including case management, community health workers, promotoras, and patient navigators. In this paper, we will review the characteristics of care coordination interventions for persons with HIV and the findings in the literature about their association with HIV health outcomes. We will conclude with a discussion of the implications and important areas for further investigations on this topic.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Management of sarcomas of the head and neck.

Soft tissue and bone sarcomas in the head and neck are rare tumors. The 1000 to 1500 yearly cases in the United States are distributed among at least 10 main histologies and multiple head and neck subsites. Although this makes structured studies difficult to perform and high-level evidence-based treatment algorithms difficult to find, basic treatment recommendations can be made from the existing literature for most histologies and subsites. This paper discusses the epidemiology, natural history, and treatment approaches for several of the most common head and neck sarcomas, including the "adult soft tissue sarcomas," osteosarcoma, chondrosarcoma of the larynx, angiosarcoma, rhabdomyosarcoma, desmoid tumors, and dermatofibrosarcoma protuberans.

Chondrosarcoma↗
PubMed2006

"Juvenile" oncology--a missing subspecialty. The experience of a reference cancer centre.

INTRODUCTION: Despite unique tumor epidemiology and a higher cancer incidence compared to pediatric patients, adolescents and young adults have not been receiving specialized, multidisciplinary, centralized care. In an effort to emphasize this need, we present outcome and toxicity data from a reference centre. METHODS: Cohort of 150 patients aged 15-30 treated for malignant tumors of lymphoid and solid organs from 1986 to 2002. RESULTS: Patients aged 15-19 commonly had lymphomas, germ cell tumors and pediatric sarcomas, whereas those aged 20-30 experienced germ cell tumors, lymphomas, melanomas and epithelial tumors more often. Overall 5- and 10-year survival was 80%, whereas 5-year and 10-year time to treatment failure was 68% and 43.5% respectively. 24% of patients experienced persistent, late treatment-related toxicities that interfered with their normal lifestyle. CONCLUSION: Despite the need for specialized care, psychosocial support and enrollment in clinical trials, youngsters have not been recognized as a patient group with distinct needs. Development of "Juvenile" oncology is required.

Academic Medical Centers↗
PubMed1985

A programme for nursing ethics.

This article defines nursing ethics and its place within the disciplines of ethics and nursing. The current endeavours of nursing ethics are identified as: revising codes, assisting nurses to reason ethically, and establishing the nurse's role in ethical decision-making regarding ethical issues, particular clients, and society's definition of health and illness. The authors then propose the further development of nursing ethics to examine critically the ethical dimensions of nursing practice with regards to its theories, diagnostic categories, diagnostic procedures, treatment goals and treatment procedures.

Bioethical Issues↗
PubMedDate not supplied

Maternal-fetal conflicts. Ethical and legal implications for nurse-midwives.

The problem of maternal-fetal conflict presents both ethical and legal challenges to birth attendants as well as to policymakers. This essay suggests that a crisis intervention approach to such conflicts fosters an adversarial view of the relationship between the pregnant woman and her fetus, which can be divisive and counterproductive. A better approach to maternal-fetal conflicts emphasizes mutually held goals rather than countervailing rights and uses the doctrine of informed consent to enhance the pregnant woman's ability to make responsible choices for both herself and her fetus. Nonphysician birth attendants can take a leading role by employing client-centered professional values to develop and extend this cooperative approach to maternal-fetal conflicts.

Beneficence↗
PubMed1986

Consultation-liaison psychiatry and the teaching of ethics.

Medicine has undergone a technological explosion which presents physicians with an increased need to make difficult ethical decisions. This has been met by an equivalent development in American medical schools of efforts to teach the ethics of medical practice. The courses vary widely from school to school. It is recommended that a core curriculum of basic theory be taught in preclinical years, followed by case-centered teaching in clinical years and residency. Only with real cases can the influence of the doctor-patient relationship be appreciated. Teaching of ethics cannot be divorced from the clinical reality of the doctor-patient relationship. The emotional needs of both enter into all decisions. It is offered that consultation-liaison psychiatry, which addresses the needs of both, is an ideal focus for such teaching.

Adult↗
PubMed1986

Consultation-liaison psychiatry and clinical ethics: a model for consultation and teaching.

The consultation-liaison psychiatrist is often expected to perform the role of clinical ethicist or moral arbiter in the course of responding to psychiatric consultations. This article develops the idea that certain aspects of good consultation-liaison skills make this appropriate and consultation-liaison psychiatrists ought not to shy away from helping with difficult ethical problems. However, a systematic approach to clinical ethics is usually not part of consultation-liaison training. Two simple conceptual models can provide such a systematic approach and can be used in any clinical setting. The two models can also be easily taught and lend themselves to use in structuring teaching or case conferences about clinical ethics. The first model comes from formal philosophy (summarized by Veatch) and is a four-step hierarchy of levels of moral discourse. The other model comes from clinical medicine, based on work by Siegler, and provides another four-point checklist, this time of areas that must be considered in each decision. This article presents each of these four-point frameworks, alludes to the large amount of work that underpins these ostensibly simple models, and offers a case for demonstration/discussion of how the consultation-liaison psychiatrist use the models for structuring clinical ethical decision making and teaching.

Aged↗
PubMed1989

Philosophers assess randomized clinical trials: the need for dialogue.

In recent years a growing number of professional philosophers have joined in the controversy over ethical aspects of randomized clinical trials (RCTs). Morally questionable in their utilitarian approach, RCTs are claimed by some to be in direct violation of the second form of Kant's Categorical Imperative. But the arguments used in these critiques at times derive from a lack of insight into basic statistical procedures and the realities of the biomedical research process. Presented to physicians and other nonspecialists, including the lay public, such distortions can be harmful. Given the great complexity of statistical methodology and the anomalous nature of concepts of evidence, more sustained input into the interdisciplinary dialogue is needed from the statistical profession.

Comprehension↗
PubMed1983

Informed consent and patient decision making: two decades of research.

Patient consent to medical treatment has been a subject of concern within the United States professional communities for over two decades. This paper traces the development of research literature on patient decision making and informed consent to medical treatment in three fields of research: medicine, law and the social sciences. A general model for stages in the development of scientific specialties is applied as a test for the development of informed consent as a specialty interest in each research field. Results indicate a relatively advanced stage of development within medicine and law. Research in the social science disciplines tend to lag behind in terms of cumulative number of publications. In addition, social science research which is potentially relevant to the ethical and policy issues of consent in medical treatment appears to lack a clear programmatic thrust, with little attention given to the policy implications of the work. In contrast, the medical and legal literatures indicate a direct concern with social policy and reflect attempts on the part of physicians and lawyers to influence the policy making process.

Behavioral Research↗
PubMed1987

The philosophical basis of medical ethics.

After a short introduction on the status of medical ethics as a special branch of a more general ethical theory, I try to identify its particular principles. According to my analysis there are two opposite basic principles which individuate two conflicting perspectives, i.e. the principle of sanctity of (human) life, and the principle of disposability of mere biological (human) life. Current troubles in medical ethics are mostly dependent on the fact that we are assisting a change from an ethics of the sanctity of life to an ethics of the disposability of life, and I argue for the latter.

Ethical Analysis↗