A description of the use of alternative therapies by selected nurse practitioner groups

The purpose of this study was to determine the expertise in and the extent of Nurse Practitioner (NP) utilization of 28 identified alternative therapies in providing patient care. Using a written questionnaire, a national sample of 500 randomly selected adult, family, and geriatric NP\u27s from the membership of the American Academy of Nurse Practitioners were asked to rank their frequency of utilization of 28 identified alternative therapies; Results of the study (response rate 52 percent, n=260) indicated that alternative therapies are being utilized by selected NP groups when providing patient care. The six most frequently prescribed or recommended alternative therapies were exercise, behavior modification, relaxation therapy, lifestyle diets, self-help groups, and massage. Additionally, at least one third of NPs surveyed prescribed or recommended imagery-visualization, prayer, meditation, commercial weight loss programs, and chiropractic sometimes or more frequently. Ninety percent of the NPs surveyed would like to learn more about alternative therapies; 85 percent believe that NP programs should include alternative therapies as part of the curriculum; Additional studies of other NP populations would be valuable. In the current health care climate with issues of cost containment and patient outcomes at the forefront, further research should focus on relationships between use of alternative therapies and issues of patient satisfaction, compliance, and outcomes, especially in comparison with use of more conventional modalities

Mechanisms of C. Parvum-induced coagulopathy in mice.

I.v. injection of Corynebacterium parvum (CP) into C57BL and BALB/c mice caused profound coagulation changes, featuring thrombocytopenia, decreased fibrinogen, increased fibrin/fibrinogen degradation products, and a concomitant microangiopathic haemolytic anaemia. These changes were greatest on the 9th day after CP, with recovery by Day 21. I.p. injection caused similar effects but s.c. injection was ineffective. Radiolabelled-platelet kinetics and distribution after i.v. CP indicated disseminated intravascular coagulation with rapid fibrinolysis; EACA treatment exacerbated the thrombosis. The coagulopathy correlated with hepatosplenomegaly, and both were dose dependent. Splenectomy did not effect the coagulopathy, but indomethacin totally abrogated the changes, suggesting that prostaglandin biosynthesis is involved in the pathogenesis

Metastable lifetimes in a kinetic Ising model: Dependence on field and system size

The lifetimes of metastable states in kinetic Ising ferromagnets are studied by droplet theory and Monte Carlo simulation, in order to determine their dependences on applied field and system size. For a wide range of fields, the dominant field dependence is universal for local dynamics and has the form of an exponential in the inverse field, modified by universal and nonuniversal power-law prefactors. Quantitative droplet-theory predictions are numerically verified, and small deviations are shown to depend nonuniversally on the details of the dynamics. We identify four distinct field intervals in which the field dependence and statistical properties of the lifetimes are different. The field marking the crossover between the weak-field regime, in which the decay is dominated by a single droplet, and the intermediate-field regime, in which it is dominated by a finite droplet density, vanishes logarithmically with system size. As a consequence the slow decay characteristic of the former regime may be observable in systems that are macroscopic as far as their equilibrium properties are concerned.Comment: 18 pages single spaced. RevTex Version 3. FSU-SCRI-94-1

Test of the Kolmogorov-Johnson-Mehl-Avrami picture of metastable decay in a model with microscopic dynamics

The Kolmogorov-Johnson-Mehl-Avrami (KJMA) theory for the time evolution of the order parameter in systems undergoing first-order phase transformations has been extended by Sekimoto to the level of two-point correlation functions. Here, this extended KJMA theory is applied to a kinetic Ising lattice-gas model, in which the elementary kinetic processes act on microscopic length and time scales. The theoretical framework is used to analyze data from extensive Monte Carlo simulations. The theory is inherently a mesoscopic continuum picture, and in principle it requires a large separation between the microscopic scales and the mesoscopic scales characteristic of the evolving two-phase structure. Nevertheless, we find excellent quantitative agreement with the simulations in a large parameter regime, extending remarkably far towards strong fields (large supersaturations) and correspondingly small nucleation barriers. The original KJMA theory permits direct measurement of the order parameter in the metastable phase, and using the extension to correlation functions one can also perform separate measurements of the nucleation rate and the average velocity of the convoluted interface between the metastable and stable phase regions. The values obtained for all three quantities are verified by other theoretical and computational methods. As these quantities are often difficult to measure directly during a process of phase transformation, data analysis using the extended KJMA theory may provide a useful experimental alternative.Comment: RevTex, 21 pages including 14 ps figures. Submitted to Phys. Rev. B. One misprint corrected in Eq.(C1

Implicit trust in clinical decision-making by multidisciplinary teams

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established

Implicit trust in clinical decision-making by multidisciplinary teams

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established