Statins in pneumonia - magic versus science?

Several studies have investigated the use of statins as an adjunct in the treatment of pneumonia, some with conflicting conclusions. The most recent of these large observational studies again suggests statin use is associated with an improved outcome for patients with pneumonia. How best to incorporate these findings into current practice is of great interest. Hidden confounders plague database interrogation and so cast doubt on the real or causal nature of observed associations. Data from large, observational studies must be complemented by smaller biological studies and randomised controlled trials in an effort to complete missing pieces in the biological puzzle of the use of statins in patients with pneumonia.     

The state of rehabilitation research: art or science?

Rehabilitation research has been criticized as not standing up enough to the rigors of scientific method to be called "science." The field has been portrayed as slow to promote its scientific achievements and to include them under the rubric of evidence-based rehabilitation. Following in the footsteps of psychology, rehabilitation as a broad-based discipline has faced many similar obstacles in achieving scientific status. Controversy exists about what exactly constitutes rehabilitation science versus its art and its respective multidisciplinary domains. The conception of these domains is directly related to current methods available to assess the state of the discipline and its research accomplishments. I used quantitative methods, such as randomized clinical and/or controlled trials (RCTs) and systematic reviews, to assess the status of rehabilitation research. Findings suggest that, as a field, rehabilitation makes significant contributions to science, measurable by the number and quality of RCTs and systematic reviews conducted so far on topics of critical importance for clinical care. In "artful" complement, qualitative approaches can be used as research tools to aid investigators in seeking knowledge beyond that obtained by quantitative methods, assessing many complexities associated with the various contexts of rehabilitation research. Other requirements to develop a common vision of rehabilitation science are also discussed.     

The hard art of soft science: Evidence-Based Medicine, Reasoned Medicine or both?

In the past 14 years, Evidence-Based Medicine (EBM) has enjoyed unprecedented developments and gained widespread acceptance among health professionals. However, should we be content with producing, critically appraising and using the best evidence available for our understanding of health problems and decision making about them? Are our convictions about EBM's relevance, our conviction and intellectual satisfaction with its mastery and adoption enough? Should we continue pushing forward along this promising path, or should we further diversify the content and scope of EBM? Is EBM the only way to view medicine in the near future? This paper presents some options to choose from in terms of direction and content as well as questions to answer given the current EBM crossroads. More intensive and extensive EBM combined with 'other features'-based medicines may be the preferred strategy to follow in the future to determine the development, use and evaluation of EBM. Argument-based medicine or Reasoned Medicine is one of the options that can be integrated into the mainstream of medical reasoning and decision making.     

Reflections on technology: increasing the science but diminishing the art of nursing?

Technology has had a huge impact on the delivery of health care over the last 10-20 years and although this has been, in general, in the Intensive Care (ICU) environment, the Accident and Emergency (A & E) department has not been immune from technical developments and innovations, a trend that looks destined to continue. The impact of technological developments has given rise to much nursing literature relating to the effects technology has had in 'dehumanizing' the patients in their care, as critical care nurses in all fields endeavour to balance the need for technical competence with the traditional and still important traditional arts of nursing. This paper explores some of the definitions and terminology surrounding technology, nursing, art and science in an attempt to illustrate that technical proficiency, scientific knowledge and nursing artistry can be combined by skilled nurses to achieve a balance of care which preserves the humanity and dignity of patients and their relatives in a critical care environment.     

Diet therapy--a forgotten art?

This study evaluated paediatric nursing students' knowledge of diet therapy to establish whether it was sufficient to prepare them for practice. A questionnaire sampled 19 1st-year and nine 4th-year students' diet therapy knowledge in relation to chronic renal failure, cystic fibrosis, juvenile diabetes mellitus and liver disease. The knowledge of 1st and 4th-year students was compared and then evaluated against criteria, devised by the researcher to measure whether this knowledge level was sufficient for practice. The Mann-Whitney Utest showed a significant difference between the 1st and 4th-years' diet therapy knowledge. The mean score for overall diet therapy knowledge of 4th-year students was 46 per cent. The results suggest that knowledge of diet therapy is insufficient to prepare nursing students for practice and that this topic needs further emphasis in paediatric nurse education.     

Learning clinical teaching. Is it magic?

Clinical teaching in nursing is a complex phenomenon that lacks a coherent theoretical base and is perplexing to novices, who tend to teach as they were taught. Nursing educators must find strategies to assist novice clinical teachers to learn the practice of clinical teaching. This article reports on the findings of a qualitative study that describes the process of learning clinical teaching through the voices of five novice and five expert clinical teachers. Essential differences between novices and experts are presented, and the challenges of preparing clinical teachers are discussed.     

What is nursing science?

The enigma of defining nursing science is preceded by defining nursing, science, research, and nursing theory-guided practice. The context for exploring the meaning of nursing science is provided through examination of the totality and simultaneity paradigms. Differing views of nursing as a discipline are discussed. The position is taken that nursing is a basic science with various nursing schools of thought that constitute the substantive knowledge of the discipline. Finally, a definition of nursing science is presented that is broad enough to encompass all disciplinary knowledge. Despite current challenges, an optimistic vision is emerging. The nurse theorists and other nurse scholars who are furthering the development of this work are considered to be the cultural creatives of nursing and contributors to a larger movement toward wholeness in science and in society.