Computerized encounter registers in primary care research: Is there a gold standard?

Computer technology as well as the need to conduct research in primary care settings, has stimulated the creation in the U.S. of information networks linking private physicians' offices and other primary care practice sights. These networks give rise to several problems which have philosophic interest. One is a “numerator problem” created by the difficulty in primary care of using the more complicated or invasive diagnostic technologies commonly employed in tertiary care research. Another is a “denominator problem” arising from the difficulties in determining which and how many patients constitute the population from which a practice is drawn. Finally, this mode of research raises questions about the social construction of medical reality and how “objective” medical truth is actually based on carefully selected patient experience. All these questions combine to challenge the “gold standard” view on medical research: the idea that some sorts of medical knowledge are epistemologically privileged and can serve as a bench-mark to determine whether new data are valid.     

Practising family therapy in India: how many people are there in a marital subsystem?

Systemic therapy would appear to be a viable form of treatment for people who exist in cultures that contain complex, extended family systems, such as those found in India. The practice of family therapy in India has evolved from Western concepts. These concepts appear to offer Indian therapists relevant and practical ways of working with families. However, some of these concepts need modifying before they can be used in an Indian context. Indian families may have very different worldviews and ideas of 'self' compared to families in the West, leading to different family organization. The situation can be further complicated by the cultural norms of therapists themselves. Therapists in India are often highly educated, come from upper-middle-class families and have been exposed to different cultures. They increasingly share many of the values of their counterparts in the West. At the same time, they retain aspects of their own cultural heritage, which is also the dominant culture for a large number of the families with whom they work. Thus, not only must Indian family therapists seek to work in culturally appropriate ways; they must also tolerate their own internalized conflicts regarding differing cultural norms. With the use of clinical data, this paper describes some of the personal and professional problems experienced by an Indian family therapist working with Western constructs of family organization.     

Conflict or harmony? Clinical research and the medical press in Russia

The author relates conditions for conducting clinical trials in Russia, current experiences of ethics committees, areas where conflicts of interest can occur regarding publishing the results of clinical trials in medical journals and the state of medical journalism in Russia today. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The author is a science editor of Meditsynskaya Gazeta.     

Family therapy research: What are the most important variables?

This report summarizes the results of a nearly day-long session of a group of experienced and distinguished family therapy practitioners and researchers. The task the group set for itself was to begin delineating the most important variables to attend to in understanding family therapy and evaluating its effectiveness. With full recognition that such a task could be only partially and tentatively accomplished in the time allotted, a great many such variables were outlined.     

Family therapy research: Comment on “research as a family therapy intervention technique”

Wright's emphasis on and illustration of the use of family therapy research as a unique intervention technique for therapy is an important contribution to the practice literature. Equally important, however, is the isomorphic shift in focus of the family therapy researcher. Rather than focusing only on process or outcome research, family therapists should become more interested in their clients as research subjects. Though rarely discussed in the family therapy literature, the competencies of family therapists as researchers and the utility of research in a family therapy context is critical to being a well-rounded professional. Examples are provided of how this emphasis is being introduced in a PhD family therapy program.     

Postgraduate research students: People in context?

This article seeks to explore learning, development and academic success, using postgraduate research students' experiences and relating them to submission and completion rates. The perceptions and circumstances of a sample of postgraduate research students from one cohort in a large civic university were examined via questionnaire and interviews. Significant associations between data gained via questionnaire and outcome of research study are presented, together with qualitative illustrations from comments and interviews with participating individuals. A developmental, sociocultural understanding of the learner is discussed. This supports a brief review of a package of practical measures designed to assist universities to support research students, especially those who may have difficulty negotiating the experience of research study, and their supervisors, and ultimately improve retention and submission rates.     

Are there qualitative differences in reading behavior between dyslexics and normal readers?

This study asked whether the reading behavior of dyslexics differs qualitatively from that of normal children. Thirty-seven children who had been identified is dyslexic (mean age 11 years, 9 months) were matched with 37 normal readers (mean age 8,6) on ability to read regular words. The dyslexics' and normals' levels of performance on nonsense words and exception words were strikingly close. Also, patterns of individual differences were similar for the two groups. The results suggest that these dyslexics are delayed in the development of both spelling-sound rules and word specific associations. They do not support the view that dyslexics have a specific deficit in the use of spelling-sound rules, or that dyslexics show more extreme individual differences than do normal readers.     

Focus on "cognition" in cognitive behavior therapy for ocd: is it really necessary?

The past decade has witnessed a significant shift toward a more cognitive emphasis in our understanding and treatment of obsessive-compulsive disorders (OCD). This article discusses the shortcomings in more standard behavioral treatment of OCD, which despite its demonstrated efficacy, led to the recent cognitive-behavioral approaches to the disorder. Current cognitive behavior therapy for OCD is described and a short critical review of the comparative treatment outcome literature on cognitive behavior therapy vs exposure and response prevention is provided. The article concludes that although the clinical utility of a more cognitive approach to OCD has not been consistently demonstrated, it would be premature to abandon cognitive formulations until some key research questions have been addressed.     

Statistical inference in behavior analysis: Environmental determinants?

Use of inferential statistics should be based on the experimental question, the nature of the design, and the nature of the data. A hallmark of single-subject designs is that such statistics should not be required to determine whether the data answer the experimental question. Yet inferential statistics are being included more often in papers that purport to present data relevant to the behavior of individual organisms. The reasons for this too often seem to be extrinsic to the experimental analysis of behavior. They include lapses in experimental design and social pressure from colleagues who are unfamiliar with single-subject research. Regardless of whether inferential statistics are used, behavior analysts need to be sophisticated about experimental design and inferential statistics. Such sophistication not only will enhance design and analysis of behavioral experiments, but also will make behavior analysts more persuasive in presenting rationales for the use or nonuse of inferential statistics to the larger scientific community.     

Animal research in psychology: declining or thriving?

From Dialog's PsychINFO database the number of studies with 6 species reported in the Psychological Abstracts was calculated for each year from 1967 to 1988. Also, the number of studies with an additional 11 species were calculated for each year from 1973 to 1988. A hand search in the Journal of the Experimental Analysis of Behavior and Learning and Motivation was also conducted to explore trends in studies on 12 species from 1970 to 1987. The numbers of studies on many species (e.g., baboons, bats, chimpanzees, dolphins, gerbils, guinea pigs, gorillas, hamsters, lemurs, mice, pigeons, rats, seals, and snakes) have remained stable. There has, however, been a steady decline in the numbers of studies on selected species (e.g., cats, dogs, and rabbits). Possible reasons for changing trends in studies on selected species include: increased costs, the cognitive emphasis in psychology, and arguably, animal rights activism.     

Feedback from research participants: are member checks useful in qualitative research?

It is often assumed that use of so-called “member checks” improves the credibility of qualitative research. Published literature mentioning member checks was reviewed to identify the purposes and procedures for seeking feedback from research participants as well as outcomes reported from member checks. Four themes reflecting underlying assumptions about the purposes of research that have implications for member checks were identified: theory generalisation, representation, participation, and change. Member checks are unlikely to be relevant to research focussed on theory development and generalisation. For other types of research, member checks might be justifiable, but there was little evidence that member checks improved research findings. Member checks can be useful for obtaining participant approval for using quotations or case studies and where anonymity cannot be guaranteed. In evaluation, stakeholder reviews of draft reports can be seen as good research practice. In participatory or collaborative research, ongoing contact might include member checks.