循证医学的辩证思维

随着临床医学的发展,临床医生面临着从理论知识加个人经验的医学模式向以科学证据为基础的医学模式转变。越来越多的卫生政策和诊疗指南的制定需要以高质量的研究结果为依据,如随机对照研究的结果,特别是随机对照研究的系统综述结论。循证医学模式要求医生在临床工作中不断提出问题并通过严格的科研设计来回答这些问题,同时强调不断进行知识更新,掌握最新研究证据以指导其临床工作。同时政府部门也鼓励发展循证医疗,因为它可通过研究有效的诊疗手段来提高卫生保健的效率。此外还有迹象表明法律决策过程中要参考是否遵循了研究证据和临床指南。知情的服务对象也促使临床工作者寻求研究证据作为依据,为了提高服务质量并且充分把握特殊专业领域的现状,临床工作者也需要不断了解新的依据信息。在众多的研究信息中,我们应对每项证据的研究方法、研究对象及观察的终点进行认真分析,确定该结论是否真实并适合我们的实际,从而制定有据可查的诊疗方案。     

Embodied Knowledge and Making Sense of Prenatal Diagnosis

Open-ended, qualitative interviews with women to whom amniocentesis was offered were analyzed to understand how women made sense of these tests. We found that women, whether tested or not, negotiated with biomedical information. They transformed it through identifiable processes, then wove it with their own instincts and beliefs and with their personal experiences, thereby creating embodied knowledge on which their decisions were based. Women who were and were not tested may have differed from each other when categorized on the basis of a final, binary choice, but they were more alike than unalike in reaching this point. The apparent importance of embodied knowledge suggests the critical role of the listening activities of the genetic counselor and of awareness of the validity and importance of women's complementary ways of knowing and doing in understanding the uses and meanings of prenatal genetic testing.     

The influence of adults' actions on children's inferences about word meanings

This article first establishes the effect of adults' actions on children's inferences about the shape and material of solid objects, based on data from Japanese 2-, 4-, and 6-year-olds. Japanese 2-year-olds are already sensitive to adults' actions in making inferences, and children become more adept at this as they become older. The invariance of the phenomenon of the effect of actions is then discussed in terms of three of its aspects: across age groups, across languages (the universality of the effect), and across tasks in lexical development. It is suggested that while specific linguistic characteristics (e.g., the means of individuation of entities), and complexity of object shape probably influence the effect of actions, action effects may have a potentially invariant/universal aspect.     

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Two Envelopes and Binding

This paper describes a way of defending a modification of Eckhardt's [2013] solution to the Two Envelopes Paradox. The defence is based on ideas from Arntzenius, Elga, and Hawthorne [2004].     

Be aware of the rifle but do not forget the stench: differential effects of fear and disgust on lexical processing and memory

The aim of this study was to investigate the role of discrete emotions in lexical processing and memory, focusing on disgust and fear. We compared neutral words to disgust-related words and fear-related words in three experiments. In Experiments 1 and 2, participants performed a lexical decision task (LDT), and in Experiment 3 an affective categorisation task. These tasks were followed by an unexpected memory task. The results of the LDT experiments showed slower reaction times for both types of negative words with respect to neutral words, plus a higher percentage of errors, this being more consistent for fear-related words (Experiments 1 and 2) than for disgust-related words (Experiment 2). Furthermore, only disgusting words exhibited a higher recall accuracy than neutral words in the memory task. Moreover, the advantage in memory for disgusting words disappeared when participants carried out an affective categorisation task during encoding (Experiment 3), suggesting that the superiority in memory for disgusting words observed in Experiments 1 and 2 could be due to greater elaborative processing. Taken together, these findings point to the relevance of discrete emotions in explaining the effects of the emotional content on lexical processing and memory.     

Career guidance in five English independent schools

English independent schools are not required to follow government statutory guidance in a number of aspects including career education and guidance, and yet many are actively engaged in careers work and this has caught the attention of policymakers. State schools are subject to statutory guidance but, according to Ofsted and other authorities, the majority fail to adequately support young people through their post-school transitions. Using evidence from five English independent schools, the type of provision they offer is analysed against benchmarks of good practice to identify where their support is focussed. The factors that shape the resourcing and design of career education and guidance in the five schools are also explored. The extent to which the practices observed in the case studies can be replicated in all, or a sub-set of state schools, is discussed in the light of policy influence of independent schools.     

A qualitative analysis of strategies for managing suicide-related events during deployment from the perspective of Army behavioral health providers,chaplains, and leaders

The purpose of this qualitative study was to investigate the use of strategies for managing suicide-related events (SREs; i.e., suicide deaths, suicide attempts, and suicidal ideation with a plan and intent to die) during deployment from the perspective of Army decision makers: behavioral health providers (BHPs), chaplains, and leaders. A total of 76 Army personnel participated in individual interviews or focus groups. Participants identified unit watch, weapon removal, medical evacuations, and debriefings as common strategies used to manage SREs in deployed settings. Many of these strategies were highlighted as short-term solutions only. Participants also underscored the importance of unit cohesion and communication among leaders, BHPs, and chaplains to effectively manage SREs. The need for structured guidelines for successfully managing SREs in deployed settings is discussed.     

What People Want From Their Professionals: Attitudes Toward Decision‐making Strategies

Attitudes toward four types of decision‐making strategies—clinical/fully rational, clinical/heuristic, actuarial/fully rational, and actuarial/heuristic—were examined across three studies. In Study 1, undergraduate students were split randomly between legal and medical decision‐making scenarios and asked to rate each strategy in terms of the following: (i) preference; (ii) accuracy; (iii) fairness; (iv) ethicalness; and (v) its perceived similarity to the strategies used by actual legal and medical professionals to make decisions. Studies 2 and 3 extended Study 1 by using a more relevant scenario and a community sample, respectively. Across the three studies, the clinical/fully rational strategy tended to be rated the highest across all attitudinal judgments, whereas the actuarial/heuristic strategy tended to receive the lowest ratings. Considering the two strategy‐differentiating factors separately, clinically based strategies tended to be rated higher than actuarially based strategies, and fully rational strategies were always rated higher than heuristic‐based strategies. The potential implications of the results for professionals' and those affected by their decisions are discussed. Copyright © 2011 John Wiley & Sons, Ltd.     

Four empirical tests of Unconscious Thought Theory

According to Unconscious Thought Theory, people make better decisions after unconscious than after conscious thought (Dijksterhuis, Bos, Nordgren, & van Baaren, 2006a). Unconscious Thought Theory yields four specific predictions. First, an exact replication of Dijksterhuis et al. (2006a) study should indicate that unconscious decisions are superior to conscious decisions. Second, decisions should improve with duration of conscious thought. Third, unconscious decisions should be superior to conscious decisions, even if unconscious decisions are deliberated while having access to information. Fourth, unconscious decisions should be based on a weighting strategy. We report results of four studies, featuring 480 participants, that yield no evidence in favor of these predictions. Therefore our findings cast doubt on Unconscious Thought Theory and its advice to base decisions on unconscious thought. The results of our studies suggest that it is better to base decisions on conscious thought while having access to information.