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PubMedDate not supplied

Women's health care: a new paradigm for the 21st century.

Oppression based on gender exists in all aspects of women's lives and transcends contemporary cultures, economic systems, and even health care services. Radical feminism provides an alternative philosophic framework of health care that is based on a women-centered viewpoint, with the experiences of women as its unifying philosophy. Midwifery is a means to apply this new philosophic approach to the health care of women. A partnership between midwifery and feminist philosophy will allow women's voices to be heard, while guiding research in women's health care in new directions, and illuminating new approaches to current health problems. The new millennium provides an opportunity to explore an alternative framework and philosophy that will change the current paradigm of women's health care.

Female↗
PubMed1999

High-dose chemotherapy: is it standard management for any common solid tumor?

High-dose chemotherapy with stem-cell support had as its basis the observation of dose-response relationships for many chemotherapeutic agents in laboratory models. The rationale to explore high-dose treatment in the clinic was further enhanced by several retrospective reviews in the 1980s which suggested delivered dose intensity of treatment was an important determinant of patient outcome. The availability of hematopoietic growth factors and technologic advances in the efficiency of stem-cell collection and administration have made the evaluation of exploring high-dose therapy safe and feasible. However, real questions remain regarding the apparently superior results of this treatment in the management of solid tumors. This paper reviews the results of high-dose chemotherapy in breast, ovarian and small cell lung cancers. Firstly the evidence for a dose-response relationship to chemotherapeutic agents in the 'standard' dosage range is examined. Secondly results of non-randomized and, where available, randomized trials of high-dose chemotherapy (HDCT) with stem-cell support are summarized and finally conclusions regarding the weight of the evidence for use of HDCT as 'standard' treatment are given. In none of these tumors is there sufficient evidence from randomized trials to consider HDCT a standard to be offered to all patients with a given stage of disease. The apparent benefit of HDCT seen in phase II trials could well be explained by such phenomena as stage shifts and patient selection. Many randomized trials in ovary and breast cancer are either ongoing or presented only as abstracts so final results must be awaited to quantify the benefit, if any of HDCT. It is acknowledged, however, that some practitioners already utilize this treatment. We speculate about the differences in philosophical approaches to cancer treatment which might contribute to early acceptance of novel therapies in the absence of adequate randomized data.

Antineoplastic Agents↗
PubMed2001

Do regulators of animal welfare need to develop a theory of psychological well-being?

The quest for a "theory of nonhuman minds" to assess claims about the moral status of animals is misguided. Misframed questions about animal minds facilitate the appropriation of animal welfare by the animal user industry. When misframed, these questions shift the burden of proof unreasonably to animal welfare regulators. An illustrative instance of misframing can be found in the US National Research Council's 1998 publication that reports professional efforts to define the psychological well-being of non-human primates, a condition that the US 1985 animal welfare act requires users of primates to promote. The report claims that "psychological well-being" is a hypothetical construct whose validity can only be determined by a theory that defines its properties and links it to observed data. This conception is used to contest common knowledge about animal welfare by treating psychological well-being as a mental condition whose properties are difficult to discover. This framework limits regulatory efforts to treat animal subjects less oppressively and serves the interests of the user industry.A more liberatory framework can be constructed by recognizing the contested nature of welfare norms, where competing conceptions of animal welfare have implications about norm-setting authority, as it does in other regulatory contexts, e.g., food safety,. Properly conceptualized welfare should include both the avoidance of distressful circumstances and the relationship between the animal's capacities to engage in enjoyable activities and its opportunities to exercise these capacities. This conception of animal welfare avoids appropriation by scientific experts. The development of the psychological well-being regulation is a good illustration of how social norms are contested and then appropriated, and a critique of this appropriation shows how it can be challenged.

Animal Welfare↗
PubMed2003

Bioethics and religions: religious traditions and understandings of morality, health, and illness.

For many individuals, religious traditions provide important resources for moral deliberation. While contemporary philosophical approaches in bioethics draw upon secular presumptions, religion continues to play an important role in both personal moral reasoning and public debate. In this analysis, I consider the connections between religious traditions and understandings of morality, medicine, illness, suffering, and the body. The discussion is not intended to provide a theological analysis within the intellectual constraints of a particular religious tradition. Rather, I offer an interpretive analysis of how religious norms often play a role in shaping understandings of morality. While many late 19th and early 20th century social scientists predicted the demise of religion, religious traditions continue to play important roles in the lives of many individuals. Whether bioethicists are sympathetic or skeptical toward the normative claims of particular religious traditions, it is important that bioethicists have an understanding of how religious models of morality, illness, and healing influence deliberations within the health care arena.

Attitude to Health↗
PubMed2002

1.3 Development of professional competences.

Competency-based education, introduced approximately 10 years ago, has become the preferred method and generally the accepted norm for delivering and assessing the outcomes of undergraduate (European) or predoctoral (North America) dental education in many parts of the world. As a philosophical approach, the competency statements drive national agencies in external programme review and at the institutional level in the definition of curriculum development, student assessment and programme evaluation. It would be presumptuous of this group to prescribe competences for various parts of the world; the application of this approach on a global basis may define what is the absolute minimum knowledge base and behavioural standard expected of a 'dentist' in the health care setting, while respecting local limitations and values. The review of documents and distillation of recommendations is presented as a reference and consideration for dental undergraduate programmes and their administration.

Competency-Based Education↗
PubMed2003

"It's like an explosion in your life...": lay perspectives on stress and myocardial infarction.

Psychological difficulties are common after myocardial infarction (MI). These difficulties are most often represented to patients through cardiac rehabilitation services and the literature offered to patients after MI as being related to "stress" and its management. However, no research has examined what MI patients understand by the term "stress" or how congruent lay views of stress are with those evident in the professional literature. The aim of the study reported here was to examine post-MI patients' views of stress, its functioning and relationship to their MI. As patients' views of stress were sought, qualitative interviews were used. A philosophical approach was taken (critical realism) that recognizes the legitimacy of both professional and lay perspectives. Data were generated in 44 semistructured interviews with 14 MI patients who were interviewed 48 hours, 1 week, 1 month and 3 months after hospital admission. While participants described their experiences after MI as being difficult, to convey this they used everyday terms such as fear, fright and worry. Rather than viewing stress as being a consequence of their MI, they perceived it to be a common cause of heart problems. Many considered stress as having a more influential role than other risk factors, such as smoking and diet. They expressed a wide variety of sophisticated and diverse views of stress and its functioning. Each of these views placed different weighting on the roles of social, personal and situational factors in contributing to the stressful reaction. Parallels were apparent between these lay accounts and theories of stress developed in the professional literature.

Adaptation, Psychological↗
PubMed1999

Maintaining health: proactive client-oriented community day treatment centres for the chronic mentally ill.

This grounded theory study compared the definition of health by clients of two rural mental health day treatment centres, Big Sky Centre and Montana Centre. Based on an original grounded theory study of seven chronic mentally ill/disabled clients in Big Sky Centre (Yurkovich et al. 1997), the core variable, 'preventing loss of control' and related properties, were validated with nine residents of Montana Centre. While establishing a 'fit' with previous research findings, differences emerged between these two centres. These differences related to the staffs' philosophical approaches in providing treatment to the chronic mentally ill. Big Sky Centre care providers empowered their clients to learn new behaviours from their peers and assume new roles such as newcomer, member and leader. They also encouraged a prosocial attitude, and created a sense of belonging through valued involvement in their treatment. Montana Centre clients were not empowered to try out new behaviours in the treatment environment, or seek social support networks among their peers at the centre, which would foster a sense of belonging. The result was that clients from Montana Centre relied on the formal healthcare system more often than clients from the Big Sky Centre. The competing forces in healthcare today--family members, mental health providers, and insurance or managed care providers--make it easy to lose sight of or fail to gain the client's perspective about their health status and maintenance, particularly as it concerns day treatment centres. The importance of the day treatment centre as a therapeutic community which requires educational processes, innovative nursing practice, and client-centred interventions will be discussed.

Adult↗
PubMed2003

"Vanished twin": an exploration of women's experiences.

BACKGROUND: Evidence suggests that in identified twin pregnancies 30 percent become a "vanished twin," that is, when two gestation sacs are identified at early ultrasound but subsequently only one fetus is seen. This study explored the thoughts, feelings, and hospital experiences of women who have a vanished twin. METHOD: The study was conducted in a large teaching hospital in northwest England from April to June 2001. The experiences of 9 women were explored through 4 focus groups and an individual interview. Nulliparous and multiparous groups were separated for homogeneity. The study's philosophical approach was based on constructivism, and the thematic analysis used a feminist interpretation to search for patterns of meanings from the women's words. RESULTS: The women wanted to be cared for in a humanistic manner, and they felt that acknowledgement of the vanished twin by the professional was important. The findings highlighted the need for better information giving to improve communication between caregivers and women. Multiparas were more prepared than nulliparas to ask for the attention that they wanted. CONCLUSIONS: Despite the small number of study participants, results suggest that maternity caregivers should be sensitive to the feelings and individual nature of a woman who has experienced a vanished twin. Humanistic approaches to communication and improved methods of information based on the development of an information sheet are advised.

Adult↗
PubMed1999

Harnessing the patient's powers of recovery: the role of the psychotherapies in the irritable bowel syndrome.

The aim of this chapter is to provide a clear and balanced account of the role of the various forms of psychotherapy in the irritable bowel syndrome (IBS). It commences with an account of the philosophical basis for psychotherapy, attempting to integrate the concepts of autonomic arousal, repression, conversion and a developmental disorder of thinking and emotional expression. These concepts are used to explain why separation and loss can lead to the development of IBS and how the gut is such an important vehicle for emotional expression. Against this background the role and philosophy of relaxation therapy, hypnotherapy, biofeedback, cognitive behavioural therapy and analytical psychotherapy are discussed. These therapies describe a philosophical approach that is quite different from biomedical treatments in that it attempts to harness the patient's own powers for recovery. For that reason the efficacy of psychotherapies cannot be evaluated by randomized controlled trials. Psychotherapies rely on the relationship between therapist and patient and vary according to whether the locus of responsibility lies mainly with the therapist or mainly with the patient. Different patients may well require different therapies.

Biofeedback, Psychology↗
PubMed2000

[Origins of dialogue: phenomenological theories of intersubjectivity in developmental perspectives and as a foundation of psychotherapeutic processes].

Recognizing the other with his/her psychic peculiarity is an important assumption for psychotherapy. But how is empathy possible? Answers are to be expected by phenomenological-philosophical approaches concerning intersubjectivity and infant research. They are described in a comprehensive way and related to each other in spite of their epistemological differences. As can be seen in the beginning of showing and reading maternal emotions (so-called "social referencing") an infant is able to show intersubjective behaviour from the age of nine months on. Research on the reflected image of the infant and the development of shame shows that consciousness of the ego is not built before the age of one and a half years. These empirically well established results contradict those phenomenological approaches claiming that the other cannot be experienced directly but via cognitive analogies of own emotions (Lipps, Husserl). They better fit an anthropology that states the human being as an innate dialogically structured one and therefore being capable of empathy. Therefore the base for a deeper understanding of the following results of psychotherapy-research is established: 1. Early infant's memories probably do not exist as isolated images but are embedded in interactional structures. 2. Strict therapeutical abstinence may be experienced as a denial of communication and may have a retraumatic effect. 3. Quality of therapeutical relationship is crucial for the success of psychotherapy.

Child↗