Appropriate spiritual care by physicians: A theological perspective

It is argued that when spiritual care by physicians is linked to the empirical research indicating the salutary effect on health of religious beliefs and practices an unintended degradation of religion is involved. It is contended that it is much more desirable to see support for the patient’s spirituality as part of holistic care. A proposal for appropriate spiritual care by physicians is offered. © Blanton-Peale Institute 200

Phronetic legal inquiry An effective design for law and society research?

Legal research has traditionally involved a technique commonly known as doctrinal method. This practice evolved over centuries of judicial and legal practice. It is directed at the identification, interpretation and application of relevant legal rules to practical human experience, and is broadly characterised by an exhaustive literature review and close reading of case law and legislation. As a practice, doctrinal method has largely not been expressly articulated by those who employ it. Consequently, legal research is often viewed as something lawyers do, rather than explain. Over time, legal scholars have expanded their research designs to incorporate methods and theories drawn from outside law – especially the social sciences – to augment doctrinal work. However, when lawyers engage in such ‘socio-legal research’ they are often criticised for failing to properly articulate the doctrinal component of their research design. We argue that Flyvbjerg’s ‘phronetic social inquiry’ can offer a useful conceptual link between doctrinal method and social science methodology. Phronetic social inquiry involves a case-based, in-depth analytic applied to specific problems, which is sensitive to value choices and power relationships, and directed to finding pragmatic solutions. We argue Phronetic social inquiry has important parallels with legal scholarship and offers a useful way of conceptualising links between doctrinal and qualitative social research. In this way, legal research may be articulated as a phronetic, transdisciplinary process directed at pragmatic problem solving

Alcohol-related liver disease is rarely detected at early stages compared with liver diseases of other etiologies worldwide

© 2019 by the AGA InstituteBackground & aims: Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly owing to the large burden of advanced alcohol-related liver disease (ALD). We investigated whether patients with ALD are initially seen at later stages of disease development than patients with hepatitis C virus (HCV) infection or other etiologies. Methods: We performed a cross-sectional study of 3453 consecutive patients with either early or advanced liver disease (1699 patients with early and 1754 with advanced liver disease) seen at 17 tertiary care liver or gastrointestinal units worldwide, from August 2015 through March 2017. We collected anthropometric, etiology, and clinical information, as well as and model for end-stage liver disease scores. We used unconditional logistic regression to estimate the odds ratios for evaluation at late stages of the disease progression. Results: Of the patients analyzed, 81% had 1 etiology of liver disease and 17% had 2 etiologies of liver disease. Of patients seen at early stages for a single etiology, 31% had HCV infection, 21% had hepatitis B virus infection, and 17% had nonalcoholic fatty liver disease, whereas only 3.8% had ALD. In contrast, 29% of patients seen for advanced disease had ALD. Patients with ALD were more likely to be seen at specialized centers, with advanced-stage disease, compared with patients with HCV-associated liver disease (odds ratio, 14.1; 95% CI, 10.5-18.9; P < .001). Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. These patients had significantly more visits to health care providers, with more advanced disease, compared with patients without excess alcohol use. The mean model for end-stage liver disease score for patients with advanced ALD (score, 16) was higher than for patients with advanced liver disease not associated with excess alcohol use (score, 13) (P < .01). Conclusions: In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-stage disease than patients with HCV-associated liver disease. Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. Early detection and referral programs are needed for patients with ALD worldwide.This study was funded by the National Institute of Alcohol Abuse and Alcoholism grants U01AA021908 and U01AA020821, a scholarship grant from the Spanish Association for the Study of the Liver (M.V.-C.), and a grants NSFC 81570530 and 81370550 from the National Natural Science Foundation of China (L.Y.).info:eu-repo/semantics/publishedVersio