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991.
Ryan?M?AntielEmail author Farr?A?Curlin Katherine?M?James Jon?C?Tilburt 《Philosophy, ethics, and humanities in medicine : PEHM》2013,8(1):13
Introduction
Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.Methods
We mailed an 8-page survey to a random sample of 2000 practicing U.S. physicians. The survey included the MFQ30 and items assessing agreement/disagreement with cost-containment and degree of objection to using cost-effectiveness data to guide care. We used t-tests for pairwise subscale mean comparisons and logistic regression to assess associations with agreement with cost-containment and objection to using cost-effectiveness analysis to guide care.Results
1032 of 1895 physicians (54%) responded. Most (67%) supported cost-containment, while 54% expressed a strong or moderate objection to the use of cost-effectiveness data in clinical decisions. Physicians who strongly objected to the use of cost-effectiveness data had similar scores in all five of the foundations (all p-values?>?0.05). Agreement with cost-containment was associated with higher mean “harm” (3.6) and “fairness” (3.5) intuitions compared to “in-group” (2.8), “authority” (3.0), and “purity” (2.4) (p?<?0.05). In multivariate models adjusted for age, sex, region, and specialty, both “harm” and “fairness” were significantly associated with judgments about cost-containment (OR?=?1.2 [1.0-1.5]; OR?=?1.7 [1.4-2.1], respectively) but were not associated with degree of objection to cost-effectiveness (OR?=?1.2 [1.0-1.4]; OR?=?0.9 [0.7-1.0]).Conclusions
Moral intuitions shed light on variation in physician judgments about cost issues in health care.992.
Shaun?Stevenson B?Lynn?Beattie Richard?Vedan Emily?Dwosh Lindsey?Bruce Judy?IllesEmail author 《Philosophy, ethics, and humanities in medicine : PEHM》2013,8(1):15
The meaningful consideration of cultural practices, values and beliefs is a necessary component in the effective translation of advancements in neuroscience to clinical practice and public discourse. Society’s immense investment in biomedical science and technology, in conjunction with an increasingly diverse socio-cultural landscape, necessitates the study of how potential discoveries in neurodegenerative diseases such as Alzheimer disease are perceived and utilized across cultures. Building on the work of neuroscientists, ethicists and philosophers, we argue that the growing field of neuroethics provides a pragmatic and constructive pathway to guide advancements in neuroscience in a manner that is culturally nuanced and relevant. Here we review a case study of one issue in culturally oriented neuroscience research where it is evident that traditional research ethics must be broadened and the values and needs of diverse populations considered for meaningful and relevant research practices. A global approach to neuroethics has the potential to furnish critical engagement with cultural considerations of advancements in neuroscience. 相似文献
993.
Bruno?FalissardEmail author Anne?Révah Suzanne?Yang Anne?Fagot-Largeault 《Philosophy, ethics, and humanities in medicine : PEHM》2013,8(1):18
In recent decades, there has been widespread debate in the human and social sciences regarding the compatibility and the relative merits of quantitative and qualitative approaches in research. In psychiatry, depending on disciplines and traditions, objects of study can be represented either in words or using two types of mathematization. In the latter case, the use of mathematics in psychiatry is most often only local, as opposed to global as in the case of classical mechanics. Relationships between these objects of study can in turn be explored in three different ways: 1/ by a hermeneutic process, 2/ using statistics, the most frequent method in psychiatric research today, 3/ using equations, i.e. using mathematical relationships that are formal and deterministic. The 3 ways of representing entities (with language, locally with mathematics or globally with mathematics) and the 3 ways of expressing the relationships between entities (using hermeneutics, statistics or equations) can be combined in a cross-tabulation, and nearly all nine combinations can be described using examples. A typology of this nature may be useful in assessing which epistemological perspectives are currently dominant in a constantly evolving field such as psychiatry, and which other perspectives still need to be developed. It also contributes to undermining the overly simplistic and counterproductive beliefs that accompany the assumption of a Manichean “quantitative/qualitative” dichotomy. Systematic examination of this set of typologies could be useful in indicating new directions for future research beyond the quantitative/qualitative divide. 相似文献
994.
H F?rstl 《Brain and language》1991,40(1):145-150
John Abercrombie (1780-1844) was considered the most eminent Scottish physician of his time. In his Pathological and Practical Researches on the Diseases of the Brain and Spinal Cord (1836, Edinburgh: John Carfrae and Son, 3rd ed.) he described the cases of 140 patients with cerebral disorders, 48 of whom suffered from language disturbances. Despite the overwhelming clinical and neuropathological evidence of a close association between language disorder and right-sided hemiparesis or diseases of the left hemisphere, and in spite of his great interest in language disorders, he made no attempt to localize the aphasic syndrome to a specific brain area. 相似文献
995.
996.
Walter C Buboltz Jr Barlow Soper Franklin Brown Steve Jenkins 《Counselling psychology quarterly》2002,15(3):229-237
College students face many challenges and live experiences that may lead to sleep difficulties, including: varied and changing schedules, repeated deadlines, increased freedom and self-responsibility, and group living arrangements, to name but a few. A high frequency of sleep difficulties is commonly reported among college student and others who encounter similar life experiences. The prevalence of sleep difficulties is explored and a rationale provided for treatment. It is suggested that interventionists need to consider the impact of sleep difficulties on their clients' immediate and long-term functioning. To help psychologists, counsellors, and therapists better ameliorate sleep problems a number of proven techniques are reviewed which are applicable to individuals in both clinical and non-clinical settings. 相似文献
997.
Many consumers purchase products in stores, where they can physically examine and touch the items. In addition, consumers shop for products online or through direct mail, where they cannot physically examine and touch the merchandise. Building on an analysis of perceptual mechanisms involved in the sense of touch, we find that products with primarily material properties, such as clothing or carpeting, are more likely to be preferred in shopping environments that allow physical inspection than in those environments that do not. We also find that there is no difference in preference across the two environments for products with primarily geometric properties, such as packaged goods, for which vision is highly diagnostic. Furthermore, when the touch properties of a material product are verbally described, this reduces the difference in preference between the two environments. 相似文献
998.
Lloyd A. Taylor Jan L. Wallander Deborah Anderson Pamela Beasley Ronald T. Brown 《Journal of clinical psychology in medical settings》2003,10(1):9-16
We conducted a randomized clinical trial of a 3-session written self-disclosure intervention for patients with cystic fibrosis (CF). Patients (n = 39) who were at least 15 years of age and diagnosed with CF participated in the intervention. Participants in the intervention arm were asked to write in the health care setting about an important emotionally distressing issue of personal significance for a 20-min period of time and two additional 20-min writing episodes at the patient's home, which were prompted by telephone calls. Patients in the control condition received standard care alone. Findings revealed that the intervention resulted in a reduction of the number of days patients spent in the hospital over a 3-month period. The intervention did not have an impact on physiological (Forced Expiratory Volume and Body Mass Index or subjective markers of health status. These findings extend those of Pennebaker's (cf., J. Smyth, 1998) demonstrating an effect of the written-self-disclosure intervention on health care utilization. These preliminary findings are promising and justify further investigation of the modified intervention in other chronic illness populations. 相似文献
999.
William P. Brown 《Teaching Theology & Religion》2003,6(4):187-189
Abstract. This brief meditation on teaching was shared at a gathering of mid‐career theological school teachers for a retreat in Scottsdale, Arizona. It draws upon the author's familiarity with the desert to provide a metaphoric exploration of the “desiccation and delight” that surprises us repeatedly in our classrooms and instructs us in humility and hope. 相似文献
1000.
Wolfgang Herzog Christoph Nikendei Hans-Christoph Friederich Bernd L?we Jana Jünger Wolfgang Eich Stephan Zipfel 《Psychotherapeut》2003,2(4):348-356
Die psychische Komorbidität internistischer Patienten im Sinne einer ICD-Diagnose des Kapitels F beträgt mehr als 35%: Neurotische, besonders somatoforme, Schmerz-, affektive Störungen und Suchterkrankungen sind häufig. Die Liegedauer ist bei psychischer Komorbidität deutlich erhöht. Es benötigen 5% der internistischen Patienten ein psychosomatisches Konsil. Neue, komplexe Behandlungsstrategien, wie Transplantationen, Kardioverter-Defibrillatoren, Medikamentenpumpen, erfordern häufig spezifische psychosoziale Interventionen. Ältere Patienten haben Erkrankungen, die zunehmend chronifizieren und komplexer werden. Damit werden Lebensqualität und psychische Komorbidität zu zentralen Outcomevariablen der Volkskrankheiten. Das zweite große Aufgabenfeld internistischer Psychosomatik ist die Untersuchung und die Behandlung psychosomatischer Patienten im engeren Sinne (Essstörungen, Schmerz- und somatoforme Störungen), weil internistische Diagnostik und Therapie erforderlich oder die Motivation der Patienten primär somatisch ist. Organisationsmodelle reichen von Konsil-/Liaisondiensten bis zu integrierten psychosomatischen Abteilungen oder Fachabteilungen an Allgemeinkrankenhäusern. Aussichtsreiche Forschungsstrategien werden neben der Erforschung psychosomatischer Mechanismen in der Entwicklung pragmatischer Behandlungsprogramme, ihrer Überprüfung in klinischen Studien und der Versorgungsforschung gesehen. Darüber hinaus sollte eine Intensivierung nationaler und internationaler Forschungsnetze erfolgen, wenn immer möglich unter Beteiligung anderer Disziplinen, um auch im Bereich der Forschung konkurrenzfähig zu bleiben. 相似文献