Spiritual and Religious Implications of Aging with HIV: A Conceptual and Methodological Review

ABSTRACT

Spirituality and religious practices can buffer people from stressful life circumstances and promote positive biopsychosocial outcomes. The beneficial effects of spirituality and religious practices have been documented in aging and HIV. Unfortunately, little is known about spirituality and religious practices in older adults with HIV. As the number of older adults with HIV increases, with an estimated 91,000 adults over 50 being diagnosed with this disease in the United States, spirituality and religious practices may help HIV-positive people to age successfully. Crisis competence and spiritual trajectories are ways of conceptualizing spiritual development when confronting aging with a life-changing event such as a being diagnosed with HIV. Methodological issues in studying spirituality in adults aging with HIV are identified including defining spirituality and religiosity, heterogeneity of the population, timing of diagnosis, mode of transmission, sexual orientation, religious and cultural stigma, and hardiness. Implications for possible interventions are also posited.     

Meta-analysis of CBT for Bulimia Nervosa: Investigating the Effects Using DSM-III-R and DSM-IV Criteria

This meta-analysis reports the effects of cognitive-behavioural treatment (CBT) on bulimia nervosa as defined by the DSM-III-R or DSM-IV criteria. In a previous meta-analysis, 26 studies were included using less strict diagnostic criteria for inclusion. The present meta-analysis only included randomized controlled studies fulfilling the DSM-III-R or DSM-IV criteria. Computer searches in MedLine, PsychLIT and references cited herein resulted in a large number articles, of which only seven fulfilled the criteria for inclusion. Effect sizes for binge eating and purging frequency were estimated using both between-group (treatment vs control) and within-group (pre- vs post-treatment) comparisons. The combined within-group effect size for binge eating was r = 0.55 ( d = 1.32) and for purging r = 0.61 ( d = 1.54). The corresponding combined effects for the between-group comparisons were r = 0.23 ( d = 0.47) and r = 0.28 ( d = 0.58), respectively. The combined probabilities for frequency of purging in between- and within-group comparisons were p = 0.00001 and p = 0.00000001, respectively. Although the number of studies included in the meta-analysis was limited, the obtained results are in line with the findings of the previous meta-analysis, and support the efficacy of CBT for the treatment of bulimia nervosa. This suggestion is also supported by the fact that in all the studies except one, comparison groups had received other active treatments.     

From Standardization to Adaptation: Clinical Trials and the Moral Economy of Anticipation

Hailed as the gold standard, the randomized controlled trial (RCT) occupies a hegemonic position at the top of evidence-based medicine’s hierarchy of knowledge. It is testament to the methodology’s capacity for standardization that it can so readily be spoken of in the singular: the RCT. Under what conditions, then, is it possible to speak of change in the gold standard? Since the 1950s, alternative versions of the RCT have been advocated for under the banner of ‘adaptive design’. Adaptive designs allow investigators to make pre-planned changes to a trial on the basis of accruing information while the experiment is ongoing. Initially a niche topic of methodological debate among biostatisticians, the approach is becoming widespread in mainstream drug development. A genealogical analysis exposes the discursive moves used to justify and popularize adaptation, from a focus on patient well-being and the greater good in the 1960s and 1970s, to efficiency and virtualism in the 1990s and 2000s. Changing discourses of time and patienthood have facilitated a move away from standardization as the singular logic of trials towards an appreciation of flexibility, undergirded by probabilistic methodologies. Adams et al.’s [(2009). Anticipation: Technoscience, life, affect, temporality, Subjectivity, 28, pp. 246–265] conceptual framework of anticipation illuminates this evolving moral economy of medical research, in which modes of knowledge production which claim to know the future are supplanting the traditional certainties of fixed and standardized experimental designs. Predictable uncertainty is the currency of this emerging economy, which capitalizes on computer simulation and ever more sophisticated tools of prediction to leverage credibility.     

老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群。为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗。以往,手术治疗和化疗的应用随着年龄的增高而明显减少。我们一直以为老年人手术和化疗的效果不令人满意。近期的研究改变了这一认识。证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的。即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益。所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效。腹腔镜下结肠癌根治术是对老年人安全有效的手术技术。我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益。     

我们时代的境遇——临床诊疗行为中的医患文化冲突

就临床诊疗工作中的医患文化冲突问题,从何谓文化冲突、它的行为表现、文化冲突的原因等方面进行了探讨,从认知、情感、社会心理、环境变迁、价值观多元等社会文化的层面来认识和分析医患之间的复杂关系,并就正确看待和弱化医患文化冲突提出了意见。     

知情同意对危重病患者心理影响的现状研究

探讨知情同意对危重病患者的心理影响。根据知情同意实施现状,将患者分为患者知情组、家属知情组,采用问卷调查和访谈相结合的方法对两组知情同意前、后的心理状况进行评估和比较。采取自愿方式及适宜的告知方法由患者本人知情同意,患者的心理状况与选择家属知情同意的患者无明显区别。     

社会工作视野下构建和谐医患关系的策略分析

和谐的医患关系是一切医疗活动的基础。面对当前医患关系中的不和谐现象,不同学者对其形成的原因及其对策进行了多学科的探索。作为一种以利他主义为指导的专业助人服务活动,社会工作则提供了一种介入医疗纠纷问题的崭新视角。在协调医患关系的过程中,医务社会工作需要面向病患及其家属、医护人员、医院管理层、社会及大众媒体、政府公共卫生管理部门等不同的主体,发展出不同的工作策略,扮演不同的服务角色。     

病人自主性与家庭本位主义之间的张力

在中国几千年小农经济和传统文化背景下,个人利益、个人权利一直被置于家庭之下,个人自主性被包含在家庭自主性之内,表现为一种家庭本位主义。源自西方历史、文化的知情同意移植到中国后,受传统文化观念的影响,中国人对知情同意的认知、理解以及实践方式均不同于西方人。这种不同集中表现在人们对家属同意权的认可。以个人本位主义为背景的病人自主性与中国文化中的家庭本位主义之间存在张力。对知情同意在不同文化环境中不同践行方式,应以文化宽容主义的态度对待之。     

论医护人员对患者隐私权保护的注意义务

侵害患者隐私权的医疗纠纷频发,很大原因是医护人员未履行对患者隐私保密的高度注意义务。从具体案例出发,就医护人员对患者隐私权保护的注意义务进行阐释,探究该义务产生的根源,对违反该注意义务的责任进行评析。以期提高医护人员对患者隐私权保护注意义务的重视,减少相关医疗纠纷的发生。