Sound Empirical Data Research Articles

An Ethical Analysis of the Use of 'Futility' in the 1992 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care

IN AN earlier article1we explored ethical decision making in the prehospital emergency setting with particular attention to emergency cardiac care (ECC). We argued in support of recent efforts to develop portable do-not-resuscitate (DNR) policies that allow patients' wishes to be honored outside the hospital setting, such as during interinstitutional transfer, in long-term care facilities, in the home, or elsewhere. We also proposed allowing emergency personnel to cease futile resuscitation in the field. We argued that unlike DNR orders, a judgment that resuscitation is futile should rest with qualified medical personnel and should reflect a professional consensus supported by sound empirical data. In this article, we examine the most recent American Heart Association (AHA)Guidelinesfor cardiopulmonary resuscitation (CPR) and ECC.2While we commend the new guidelines for acknowledging medical futility, we identify shortcomings in the definition of medical futility and suggest further revisions.

Clozapin in der Langzeitbehandlung schizophrener Patienten

Clozapine has advantages over standard antipsychotics in refractory schizophrenia. Studies on the efficacy of clozapine in the maintenance treatment are sparse and suffer from methodological limitations. Despite this fact clozapine ranked second in a survey dealing with the preference of this antipsychotic in the long-term treatment of schizophrenia. Doctors report on using a mean of 130 mg/d in this indication which is considerably less than the doses used in most of the published long-term trials. The discrepancy between the popularity of clozapine and the lack of sound empirical data on its long-term efficacy is discussed.

Developing Structures for Accountability in a Hospital Social Work Department: An Empirical Approach

The paper describes how a Hospital Social Work Department has attempted to provide some structures to meet the current challenges in health care of quality, access and cost. The use of a computerised patient information system is linked to the development of a management programme designed to generate priorities of service and to provide a framework for case review. The second part of the paper focuses on structures for determining the needs of key target populations and means of gaining access to social work services. The last section relates the question of cost effectiveness to time spent in direct and indirect service, patient need and access to community support. The paper argues that in order to develop effective structures for accountability in hospital Social Work Departments it is necessary to have sound empirical data on patient populations, problems encountered and service provided and illustrates this by reference to the above studies.

Teenage parenting and child development: a literature review.

Research on teenage parenting together with medical and behavioral research related to child development is reviewed in an effort to determine causal factors related to reported developmental deficits among children of teenage parents. 4 general conclusions are suggested: 1) several researchers agree that children of teenage parents show poor social and intellectual competence when compared with children on non-teen parents. However, the amount of sound empirical data to support this view is minimal. For example, there are few published studies of the longterm effects of teenage parenting or of actual behavioral interactions of teenage mothers and their children. 2) It is unlikely that research along the lines of the "continuum of reproductive casualty" will lead to identification of causal factors sufficient to account for developmental deficits in children of teenage mothers. 3) Research along the lines of "the continuum of caretaking casualty" suggest numerous behavioral and environmental variables that may be related to the development of children of teenage mothers. 4) Research designs applied to the study of teenage parenting must shift from linear models to complex multivariate models that permit simultaneous analysis of organismic, environmental, and behavioral determinants of development. Finally, mental health specialists, government agencies, and researchers alike, must be willing to entertain the hypothesis that much of our knowledge of the childrearing skills of teenage mothers is based on myth rather than empirical fact. 1 such myth may be that below 19 years of age, maternal age in and of itself is an important determinant of infant development and parent-infant interaction. Poor social-economic status, family support systems, marital stability, nutrition and prenatal care may be far more important determinants of development for these children than the age of their mothers.

Marital Homogamy the Second Time around

Recent declines in the marriage rate and increases in the prevalence of remarriage point to the need for more careful analysis of the nature of second marriage. Very few sound empirical data are available concerning the mate selection or adjustment processes of second marriages, and this hampers the development of useful, generalized knowledge about remarriage. Utilizing data from the 1970 National Fertility Survey, this paper compares the levels of marital homogamy-in age, education and religious identification-of women in their first marriages and women in their second marriages, as well as in the previous marriages of the twice-wed women. The analysis shows that twice-wed women experience low homogamy in both their current and first marriages. The persistence of this pattern through the application of controls for status, age, and religiosity indicates that the differences do not result primarily from marriage market constraints. Though several caveats are noted, the results support the perspective that some women, either because of their conception of marriage, or because of their mate selection pattern, are disproportionately prone to divorce and remarry. The implications of these findings for divorce trends are discussed.

The Challenge of Democracy in the Muslim World

Is it true that in the Muslim world the more Islamic a country is the less likely it is to be democratic? This type of question may sound empirical data produced by the Freedom House (2001) discloses this tendency. Out of 47 countries in the world with Muslim majorities, only 11 (or 23 per cent) can be regarded as haring truly adopted-democracy and have gone through a relatively stable period of the-consolidation of democracy. Meanwhile, in the non-Muslim world, 110 out of 145 countries (more than 75 per cent) have democratically elected governments. We may draw the conclusion from this data that in the non-Muslim world, a country is three times more likely to be democratic than one in the Muslim world.DOI: 10.15408/sdi.v9i1.679