利益冲突

探讨利益冲突的概念及其要素,影响利益冲突的可能因素。利益冲突的危害,并在探讨这些问题基础上提出处理利益冲突的若干措施。     

浅析脑胶质瘤临床试验中知情同意的问题

通过对医院目前开展的脑胶质瘤临床试验知情同意过程中的观察,综合科室脑胶质瘤临床试验的开展情况,针对不同类型脑胶质瘤病人尤其是功能区受损以及伴有认知功能受限的病人,分析签署知情同意过程中存在的问题,经探讨并提出整改及解决办法。通过规范的签署知情同意,针对病情不同的脑胶质瘤受试者采取个体化签署知情同意,充分尊重受试者意愿,保证临床试验顺利进行,使受试者权益得到充分保障,促进临床试验规范、安全、有序的开展。

     

特异性免疫疗法在儿童哮喘治疗中的应用

支气管哮喘是儿童最常见的慢性呼吸道疾病,近年来发病呈逐年上升趋势。在儿童哮喘的治疗方案中,脱敏治疗是唯一从变态反应疾病的病因治疗可改变疾病进程的疗法。注射脱敏是传统的脱敏方法,儿童疗效优于成人,但由于采用注射的方式,使该方法一直应用于5岁以上的儿童。舌下脱敏治疗是90年代开始在国外进行应用的一种脱敏治疗方法,其安全性和有效性在国外已得到多项临床研究的证实,且其安全性在儿童要优于成人,因此舌下脱敏治疗为5岁以下年幼哮喘儿童的特异性免疫治疗提供了新的思路和治疗策略。     

The Role of Consent in Sado-masochistic Practices

In 1993 the Law Lords upheld the original conviction of five men under the 1861 Offences Against the Person Act for participating in sado-masochistic practices. Although the five men were fully consenting adults, the Law Lords held that consent did not constitute a defence to acts of violence within a sado-masochistic context. This paper examines the judgements in this case and argues that sado-masochistic practices are no different from the known exceptions cited by the court to the idea that consent is no defence to violence (sport, parental chastisement and surgery). It also argues that if we can make sense of rape as a non-consensual, violent act, expressed through sex, then we can make sense of sado-masochism as a consensual sexual act, expressed through violence. This revised version was published online in August 2006 with corrections to the Cover Date.     

Altruistic Discourse in the Informed Consent Process for Childhood Cancer Clinical Trials

Scholars have debated the role that altruistic considerations play—and should play—in recruitment and decision-making processes for clinical trials. Little empirical data are available to support their various perspectives. We analyzed 140 audiotaped pediatric informed consent sessions, of which 95 (68%) included at least one discussion of how participation in a cancer clinical trial might benefit: 1) the pursuit of scientific knowledge generally; 2) other children with cancer specifically; and 3) “the future” and other vaguely defined recipients. Clinicians initiated most (80%) of these discussions of altruism. The enrollment rate of children in the clinical trial was high (83%) overall, but not higher among children whose parents were involved in an altruism-oriented discussion. These findings suggest that: (1) clinicians invoke a spectrum of altruistic considerations rather than a single monothematic notion of altruism, and (2) the effect of altruistic considerations on subsequent enrollment decisions is marginal. While further research on this topic is warranted, bioethical debate should strive to reflect the diversity of altruistic discourse in clinical research encounters and to place this discourse in the context of other, including nonaltruistic, considerations.     

Informed Consent Procedure for Clinical Trials in Emergency Settings: The Polish Perspective

Setting reasonable and fair limits of emergency research acceptability in ethical norms and legal regulations must still adhere to the premise of well-being of the research subject over the interests of science and society. Informed consent of emergency patients to be enrolled in clinical trials is a particularly difficult issue due to impaired competencies of patients’ to give consent, short diagnostic and therapeutic windows, as well as the requirement to provide detailed information to participants. Whereas the Declaration of Helsinki, Good Clinical Practice guideline, Additional Protocol to the European Bioethical Convention concerning Biomedical Research, as well as appropriate regulations adopted by the Food and Drugs Administration (USA) allow waivers from participants’ consent or deferred consent for emergency research, the regulations of most European Community countries following the Clinical Trial Directive (2001/20/EC) do not give space for a deferred consent or a waiver from consent for adult patients (unless surrogate consent is made use of). This is even more confusing in case of Poland, where conflicting regulations on a waiver from a participant’s consent in emergency research exist and the regulations on surrogate consent of temporarily incompetent adults are too restrictive and authorise only the guardianship courts to consent, which is not or hardly feasible in practice. European Community regulations need to be amended to allow for implementation of the deferred consent or waivers from consent for emergency research in order to enable ethical research of emergency conditions that should become a large part of important public health priorities.     

A Conflict in Norms; Metric Versus English Units of Linear Measurement

Summary

This study examined the relationship between incoming information and a person's attitude. The hypothesis tested was that information operates on the cognitive component of attitude which, if sufficiently reorganized, occasions change in the affective component, and that this, if sufficiently large, finally actuates the behavioral component. This hierarchical tricomponent hypothesis was tested by

(a) establishing through factor analysis that cognition, affect, and behavior (each represented by 10 Likert-type statements) were unique attitude components, and thus that dynamic consistency among them is attributable to linkages and not duplication;

(b) establishing through χ² analysis that observed triadic change patterns were significantly more consistent with the hypothesized hierarchy than chance alone would allow;

(c) establishing through a comparison of conditional component changes that the direction of the critical dyadic change patterns were consistent with the hypothesized hierarchy: namely, that cognitive change preceded affective change, and that it, in turn, preceded behavioral change;

(d) establishing through a comparison of group means that the amount of cognitive and affective change was significantly greater for those Ss experiencing affective and behavioral change, respectively, than for those Ss not experiencing such change;

(e) establishing through the use of 25 different change criteria that the foregoing results are relatively stable, and not an artifact of any specific criterion of “attitude change.”     

Client Report of Delivery of Common Elements in Usual Care and the Association to Satisfaction

Recently, scholars have advocated for the use of a new flexible approach to evidence-based practice through the use of “common elements”, which are treatment procedures that are utilized in a variety of evidence-based mental health interventions. The objective of this study was to describe the extent to which clinicians are using common elements of evidence-based treatment (EBT) in routine mental health care for children and if they are utilizing more of the elements associated with their client’s diagnosis. A second objective was to determine whether use of these elements was associated with client satisfaction. The Youth Services Survey was administered to a diverse sample of youth and their caregivers (total sample = 1075) to measure satisfaction with services and use of both talk-based and skill-based common elements. More than 74 % of caregivers indicated that their child’s clinician utilized the talk-based common elements frequently or almost always. Additionally, at least 69 % of youth agreed with this finding. Youth and caregivers reported that the common elements related to skill building were utilized less frequently. A Generalized Estimating Equation approach was used to examine the relationship between use of common elements and client diagnosis and satisfaction. The results for diagnosis were mixed and varied by parent and youth report. Finally, the more clinicians discussed and practiced common elements of EBT with their clients, both youth and caregivers were more likely to be satisfied. Due to clients’ reporting that on average clinicians utilized skill building common elements less often, targeted clinician training may be important, since practicing skill-building therapeutic elements is key to adopting new methods of managing behavior and emotions. Further, if families are more satisfied with a common elements approach, then clinicians may be more likely to utilize it.     

美国胃肠病学院结直肠癌筛查指南

本指南是对2000年美国胃肠病学院（ACG）结直肠癌（CRC）筛查建议的首次更新。cRc筛查包括癌症预防性检查和癌症检测性检查。从50岁起每10年检查一次结肠镜仍然是CRC筛查的首选策略。由于经济受限,并非所有的医院均可进行结肠镜检查;同时,也非所有的适宜人群都乐意接受出于筛查目的的结肠镜检查。     

Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems

Journal of Clinical Psychology in Medical Settings - Posttraumatic stress disorder (PTSD) is a serious mental health disorder that may not be adequately detected or treated in primary care (PC)....     

Roles and Role Conflict of Women in Infertile Couples

This study explored the experience of role conflict for women in infertile couples. The infertile group consisted of 29 women who, with their husbands, were beginning an infertility program; comparison group subjects were 29 married women with no history of inability to conceive. Each subject completed self-report instruments measuring role conceptions and expectations, the experience of role conflict, and occupational commitment. Each husband also reported his role expectations for his ideal woman. Also, a semi-structured interview was conducted with each infertile subject. Compared to the control group, the infertile group's role conceptions were more traditional; they reported less role conflict of various kinds, and they showed greater occupational commitment. They did not differ significantly on degree of wife-husband role discrepancy, or on mother's occupational commitment. These findings lead to an understanding of infertility as part of an interactional system for dealing with potentially intolerable sources of role conflict.     

Pastoral Care in Aged Care Settings: Role and Challenges

Journal of Religion and Health - This mixed methods study explored challenges faced by pastoral care workers. A development phase preceded an on-line survey completed by chaplains and pastoral...     

The Role of Psychoanalysis in the Conflict of Interpretations

This paper describes how the temporary illness of the analyst affects the analytic work when it breaks the habitual analytic setting and exposes the analyst to countertransference reactions. The illness stimulates different meanings and reactions in the analysand. The paper describes how the fostering of the habitual analytic work helps the analysand to make use of the event, i.e., to integrate it into the transference. In the light of the patient cases, it would seem that corporeality is the key: the crucial question is what it means not only to the analyst him/herself but also to the analysand, that the analyst's body remains unchanged, secure, living and stable and does not require any particular attention.