Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. Design: Prospective clinical interventional study. Setting: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. Participants: Nine junior physicians in postgraduate training. Intervention: Information on the ethics of DNR and implementation of new DNR orders. Measurements and main results: Accurate understanding, interpretation, and use of (...) DNR orders, especially with respect to the patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Objective:To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions.Design:Prospective clinical interventional study.Setting:Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland.Participants:Nine junior physicians in postgraduate training.Intervention:Information on the ethics of DNR and implementation of new DNR orders.Measurements and main results:Accurate understanding, interpretation, and use of DNR orders, especially with respect to the patients’ involvement in the (...) decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision.Conclusion:An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Background Decisions regarding Cardio-Pulmonary Resuscitation (CPR) and Do Not Attempt Resuscitation (DNAR) orders remain demanding, as does including patients in the process. Objectives To explore physicians’ justification for CPR/DNAR orders and decisions regarding patient inclusion, as well as their reports of how they initiated discussions with patients. Methods We administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. Results Justifications were provided for 59% of DNAR orders and included (...) severe comorbidity, patients and families’ resuscitation preferences, patients’ age, or poor prognosis or quality of life. Reasons to include patients in CPR/DNAR decisions were provided in 96% and 84% of cases, and were based on respect for autonomy, clinical assessment of the situation as not too severe, and the view that such inclusion was required. Reasons for not including patients were offered in 84% of cases for CPR and in 70% for DNAR. They included absent decision-making capacity, a clinical situation viewed as good (CPR) or offering little hope of recovery (DNAR), barriers to communication, or concern that discussions could be emotionally difficult or superfluous. Decisions made earlier in the patient's management were infrequently viewed as requiring revision. Residents reported a variety of introductions to discussions with patients. Conclusions These results provide better understanding of reasons for CPR/DNAR decisions, reasons for patient inclusion or lack thereof, and ways in which such inclusion is initiated. They also point to potential side-effects of implementing CPR/DNAR recommendations without in-depth and practical training. This should be part of a regular audit and follow-up process for such recommendations. (shrink)

Louis Perron Le discours cosmologique actuel permet-il d’affirmer le caractère théophanique du cosmos, au sens où celui-ci pourrait être considéré comme le lieu de la manifestation visible et immédiate de Dieu? Plus généralement : est-il en mesure d’ouvrir un chemin vers la foi? Contrairement à un discours récurrent, l’auteur, s’appuyant sur l’oeuvre de Jean Ladrière, défend la thèse qu’il n’existe pas de voie royale conduisant de la science à la foi. Celle-ci peut cependant recueillir l’image scientifique du monde et (...) lui conférer une signification propre, moyennant un parcours herméneutique s’appuyant sur l’articulation des différents registres de sens et dont la médiation philosophique constitue le passage obligé. (shrink)

Cet article présente un service de consultation conjugale situé en Suisse romande, non médicalisé, dont l’orientation psychodynamique et le travail auprès des couples n’est pas sans rappeler la pratique française des conseillers conjugaux-thérapeutes de couple « ancien modèle ». Si l’appellation de consultation conjugale a été retenue, malgré ses inconvénients, c’est qu’elle permet de toucher un très large public, en particulier de nombreuses personnes insuffisamment individuées pour qui l’appartenance au « Nous-couple » est constitutive. Par rapport aux objectifs de travail, (...) l’auteure explore deux voies, illustrées par deux vignettes cliniques : l’une vise à recouvrir une problématique sous-jacente en rétablissant un équilibre antérieur, l’autre à découvrir l’arrangement défensif du couple en introduisant une dynamique de changement. (shrink)

By appeal to the phenomenon of presupposition accommodation, Rae Langton and others have proposed that speakers can gain genuine authority over their audiences when they implicitly claim such autho...

Courts and jurors sometimes refuse to assign liability to defendants on the basis of statistics alone, despite their apparent reliability. I argue that this refusal is best understood as a recognition of defendants’ right to security. Understood as a robust good in Philip Pettit’s sense, security requires that someone risking harm to others’ protected interests adopt a disposition of concern that controls against wrongfully harming them. Since trials risk harm, the state must adopt such a disposition. Statistics leave open the (...) possibility of innocence and so wrongful harm in a way that the state cannot ignore; if it does use such statistics, it makes defendants wrongfully insecure. This explanation of the problem of bare statistical evidence is especially apt because security grounds the right to a fair trial and judicial procedural rights more generally. (shrink)

The question to be discussed in this paper can be put in simple terms: at what date were the collections of scholia on classical Greek authors compiled? Scholars have given two conflicting answers. The first was put forward by J. W. White in his edition of the scholia to Aristophanes' Birds. Developing an opinion of Dindorf, he suggested that the archetype of the scholia was a large parchment codex of the fourth or fifth century, which contained in the margins a (...) commentary drawn from several sources. A very similar view has been expressed about the scholia to Apollonius Rhodius and Pindar. (shrink)

Savīyahʹhā-yi maʻrifatʹāfarīn-i nafs -- Falsafah-yi Ṣadrā -- Falsafahʹī barā-yi zīstan-i safar-i ʻishq.

Aproximación al pensamiento de Rodolfo Kusch -- Canto e identidad en el Martín Fierro según Carlos Astrada y Rodolfo Kusch -- Donde el barro se subleva -- La rehabilitación del saber seminal como camino hacia una mística popular -- Kusch y el impulso social de nuestra época -- La barbarización de la civilización, una grieta de antaño -- ¿De dónde pensarnos?

Die Herrschaft des Behaviorismus in der Psychologie ist gebrochen! Das ist die Ausgangsthese dieses Buches, die im Rahmen des Modells revolutionärer Wissenschaftsentwicklung (Kuhn) als Behauptung eines Paradigmawechsels präzisiert wird. Die Argumentation beschränkt sich nicht nur auf den Nachweis des Niedergangs des Behaviorismus, sondern gibt auch konstruktiv das mögliche neue Paradigma an: als Psychologie des reflexiven Subjekts, das wie der Wissenschaftler (subjektive) Theorien aufstellt, überprüft, bewertet. Der Aufriss einer solchen Psychologie des epistemischen Subjekts unter allgemein-, sozial-, pädagogisch- und klinisch-psychologischem Aspekt thematisiert (...) vor allem: die Rationalität der Reflexionen, Normenkritik und -begründung im Austausch von wissenschaftlichen und naiven Theorien sowie die Berücksichtigung von Reflexivität in der therapeutischen Praxis. Die Rückwendung dieser pychologisch-metatheoretischen Perspektiven auf die Wissenschaftstheorie führt auch zu einer neu. (shrink)

By ‘the logic of religious language’ I understand both a problem: What is the correct account of the logic of religious language? and a theme, a recurrent theme in the modern philosophical discussion of religion, which raises a related but distinguishable question: Is the approach to religion of linguistic analysis an adequate approach? Can we do justice to the logic of religious language by attending to the recognition and analysis of different linguistic forms?

It seems that the choice for the subject "Christian Ethics in Ukrainian Culture" was made by everyone: the so-called "traditional Churches" and the authorities. The move, however, leaves much room for thought. First, who will teach this subject in educational institutions? We propose to use the experience not only of the western regions of Ukraine, including Lviv, Ivano-Frankivsk, etc., but also of the Ostroh Academy National University. When on March 24, 2000, the Rivne Regional Council decided to introduce the subject (...) of Christian ethics in Rivne schools, the National University "Ostroh Academy" became one of the basic training centers for teachers of Christian ethics. The creation of a faculty for the training of teachers of Christian ethics caused, accordingly, the recruitment of students. (shrink)

ABSTRACTEmotion regulation comprises attempts to influence when and how emotions are experienced and expressed. It has mostly been conceived of as proactive or reactive, but it may also be retroactive and involve memory. I term such past-oriented activity mnemonic emotion regulation and propose that it involves increasing or decreasing access to or altering the characteristics of a memory. People may increase access to a memory and make it more likely that it will be retrieved in the future, for example by (...) rehearsing a pleasant memory. They may decrease access to a memory and make it less likely that intrusions will be experienced in the future, for example by repeatedly trying to stop an unpleasant memory from being retrieved. Finally, people may alter the characteristics of a memory and change its content or context, for example by replacing a negative impression with a productive interpretation. I discuss how mnemonic emotion regulation may be i... (shrink)

Articles, chiefly on Islamic philosophy.

This paper answers the title question, “Yes,” on both counts. The first part of the paper argues that modern liberals are socialists, and the second part argues that they are also social democrats. The main idea behind the first argument is that the state has effectively taken control of the incidents of ownership through its taxation, spending, and regulatory policies. The main idea behind the second argument is that the institutions of social democracy are replicated by the institutions favored by (...) modern American liberalism. Specifically, the takeover of the American healthcare system, Social Security, employers' mandatory contributions to unemployment insurance, and workers' compensation insurance replicate the institutions of social democracy. (shrink)

Although the model proposed by Thelen and co-authors provides a detailed explanation for the processes underlying reaching, many aspects of it are highly speculative. One of the reasons for this is our lack of knowledge about transformation of a hand movement plan into joint movements. The leading joint hypothesis (LJH) allows us to partially fill in this gap. The LJH offers a possible explanation for the formation of movement and how it may be represented in memory. Our explanation converges with (...) the dynamic model described in the target article. (shrink)

Stiff Person Syndrome is a rare autoimmune disorder associated with antibodies against glutamic acid decarboxylase, the key enzyme in γ -aminobutyric acid synthesis. In order to investigate the role of cerebral benzodiazepinereceptor binding in SPS, we performed [ 11 C]flumazenil positron emission tomography in a female patient with SPS compared to nine healthy controls. FMZ is a radioligand to the postsynaptic central benzodiazepine receptor which is co-localized with the GABA-A receptor. In the SPS patient, we found a global reduction of (...) cortical FMZ binding. In addition, distinct local clusters of reduced radiotracer binding were observed. These data provide first in vivo evidence for a reduced postsynaptic GABA-A receptor availability which may reflect the loss of GABAergic neuronal inhibition in SPS. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A home-sent (...) questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)