一个新的中医研究范式:从非线性动力学的角度解读中医

西方对中医的研究多是利用随机控制试验来检验其疗效。通过讨论,认为这类研究有其局限性。同时探讨一种新的研究范式,即非线性动力学理论。认为这一理论能够提供理论依据来设计适合中医特征的临床试验,并可望得出为西方医学界所接受的研究结果。     

规范化治疗体系对抑郁症治疗依从性的干预研究探讨

抑郁症的药物治疗是一个长期的过程,因此治疗依从性极其重要,然而,因疾病特点、药物、医患等多方面原因,导致治疗依从性较差,如何提高治疗依从性成为备受关注的问题。国内外相关研究较多,其中系统规范的随诊模式,抑郁症及药物知识的教育,心理治疗及对家庭成员相关知识的教育干预等均被证实确实有效。本文就各种干预方法进行探讨,以期确立系统规范的随诊、治疗体系,提高治疗依从性。     

Is There an Effective Approach to Deterring Students from Plagiarizing?

The purpose of this study was to evaluate the effectiveness of plagiarism detection software and penalty for plagiarizing in detecting and deterring plagiarism among medical students. The study was a continuation of previously published research in which second-year medicals students from 2001/2002 and 2002/2003 school years were required to write an essay based on one of the four scientific articles offered by the instructor. Students from 2004/2005 (N = 92) included in present study were given the same task. Topics of two of the four articles were considered less complex, and two were more complex. One less and one more complex articles were available only as hardcopies, whereas the other two were available in electronic format. The students from 2001/2002 (N = 111) were only told to write an original essay, whereas the students from 2002/2003 (N = 87) were additionally warned against plagiarism, explained what plagiarism was, and how to avoid it. The students from 2004/2005 were warned that their essays would be examined by plagiarism detection software and that those who had plagiarized would be penalized. Students from 2004/2005 plagiarized significantly less of their essays than students from the previous two groups (2% vs. 17% vs. 21%, respectively, P < 0.001). Over time, students more frequently choose articles with more complex subjects (P < 0.001) and articles in electronic format (P < 0.001) as a source for their essays, but it did not influence the rate of plagiarism. Use of plagiarism detection software in evaluation of essays and consequent penalties had effectively deterred students from plagiarizing.     

HIV/AIDS reduces the relevance of the principle of individual medical confidentiality among the Bantu people of Southern Africa

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons living with HIV/AIDS, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients’ and families’ autonomy while at the same time benefiting the individual patient.     

What is conscience and why is respect for it so important?

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed.

Innovative Methods for Making Behavioral Science Relevant to Medical Education

Thousands of psychologists teach in U.S. medical schools, and these psychologists are responsible for ensuring that the medical students they train are aware of the ways in which research findings from the behavioral and social sciences can enhance the practice of medicine. In addition, it is imperative that physicians appreciate the limits of their own ability to treat psychological and psychiatric problems and know when to refer to mental health professionals. This brief article is based on a talk given by the author at the 2007 American Psychological Association (APA) convention after receiving the Association of Psychologists in Academic Health Centers (APAHC) Ivan Mensh Award for Distinguished Achievement in Teaching. The paper draws on the personal experiences of the author after three decades spent teaching behavioral science to medical students, and it introduces readers to the reasoning behind many of the decisions made in planning and developing each of the author’s four editions of the medical school text Behavior and Medicine.

THE EFFECTS OF BEHAVIORAL SKILLS TRAINING ON CAREGIVER IMPLEMENTATION OF GUIDED COMPLIANCE

The effectiveness of a behavioral skills training package that consisted of modeling, rehearsal, and feedback was evaluated to increase correct implementation of guided compliance by caregivers of 3 children who exhibited noncompliance. Results showed that the training package improved performance of guided compliance. Generalization probes indicated that the skills learned were exhibited in different settings 3 to 6 weeks after training ended.     

Construct validity of the medical specialty preference inventory: A critical analysis

The Medical Specialty Preference Inventory (MSPI; Zimny, G.H. (1979). Manual for the Medical Specialty Preference Inventory. St. Louis, MO: St. Louis University School of Medicine), a measure of medical students’ interests, was substantively and empirically examined to identify an underlying factor structure. A factor model for the original MSPI based on 38 factors in five general areas was evaluated on a national sample of 1014 medical students and yielded poor fit to the data. Exploratory factor analyses at the item level utilizing the full pool of MSPI items produced an 11 factor solution with 88 items. Sub-scales were identified within this model and an 11-18 higher-order model and an 18 sub-scale model also were proposed. The relative fits of the three models were evaluated by confirmatory factor analysis with the 18 sub-scale model shown to be superior. This model was cross-validated on a separate sample of 1016 medical students and fit the data well. All sub-scales exhibited adequate internal consistency across samples. These findings support the need for a revised MSPI based on 18 scales. Implications of these findings for MSPI scoring practices are discussed along with future directions.     

Predictive validity of the medical specialty preference inventory

Medical schools can assist students by providing them with quality career counseling to help them choose a medical specialty. Many schools use interest inventories to help identify students’ specialty interests. This study examined the predictive validity of one such inventory, the Medical Specialty Preference Inventory (MSPI). In a longitudinal design, we used discriminant function analysis to examine how well students’ scores on the MSPI fit their chosen medical specialty one year later. The MSPI correctly predicted students’ future medical specialty choice 58.1% of the time. These results can help career advisors interpret MSPI scores, and identify students’ most likely medical specialty choice, as well as their second most likely choice.