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41.
Systemic (family) therapy is a widely used psychotherapy approach. However, most systematic efficacy reviews have focused solely on “family‐based treatment” rather than on the theoretic orientation “systemic therapy.” We systematically review trials on the efficacy of systemic therapy for the treatment of childhood and adolescent externalizing disorders. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems‐oriented therapy in various forms (family, individual, group, multi‐family group therapy) with child or adolescent index patients (0–17 years) suffering from mental disorders were identified by data base searches and cross‐references. Inclusion criteria were as follows: index patient diagnosed with a DSM‐ or ICD‐listed mental disorder, and trial published in any language up to the end of 2011. The RCTs were analyzed for their research methodology, interventions applied, and results (postintervention; follow‐up). A total of 47 trials from the United States, Europe, and China, published in English, German, and Mandarin, were identified. A total of 42 of them showed systemic therapy to be efficacious for the treatment of attention deficit hyperactivity disorders, conduct disorders, and substance use disorders. Results were stable across follow‐up periods of up to 14 years. There is a sound evidence base for the efficacy of systemic therapy for children and adolescents (and their families) diagnosed with externalizing disorders.  相似文献   
42.

The equipoise requirement in clinical research demands that, if patients are to be randomly assigned to one of two interventions in a clinical trial, there must be genuine doubt about which is better. This reflects the traditional view that physicians must never knowingly compromise the care of their patients, even for the sake of future patients. Equipoise has proven to be deeply problematic, especially in the Third World. Some recent critics have argued against equipoise on the grounds that clinical research is fundamentally distinct from clinical care, and thus should be governed by different norms. I argue against this “difference position,” and instead take issue with the traditional, exclusively patient-centered account of physicians' obligations that equipoise presupposes. In place of this traditional view, I propose a Kantian test for the reasonable partiality that physicians should show their patients, focusing on its application in clinical research and medical education.  相似文献   
43.
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.  相似文献   
44.
Although numerous studies have indicated the significance of parental support and parent–child communication in alleviating the adverse effects of parental departure on left‐behind children, researchers have rarely addressed the impact of parent education on migrant parents. On the basis of the results of a pilot randomized controlled trial, the study reported here involved examining the possible outcomes and feasibility of a parent education program for rural‐to‐urban migrant mothers of left‐behind children in China. Informed by an existential–narrative approach to parent education, the program was composed of six 2.5‐hour sessions. The sample included 56 migrant mothers recruited from a social service center in Shenzhen, China, who were randomly assigned to either the immediate group (= 28, M = 34.82 years, SD = 4.12, aged 23–43) or the waitlist control group (= 28, M = 34.68 years, SD = 4.53, aged 28–43). The hypotheses of the trial were twofold: that the program would positively affect participants’ parental identity and that it would improve mother–child relationships and parenting practices. The results revealed no significant difference in parental identity between the intervention group and the waitlist control group at the post‐test assessment after ruling out the effects of pretest survey scores. However, significant differences did emerge in parent–child relationships and parenting practices. Overall, the results corroborate the feasibility of examining the current program for migrant mothers in China in a full trial. The findings also offer insights into developing empirically supported parent education programs for migrant parents.  相似文献   
45.
Öst (2008) recently compared the methodological rigor of studies of acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). He concluded that the ACT studies had more methodological deficiencies, and thus the treatment did not qualify as an “empirically supported treatment.” Although Öst noted several important limitations that should be carefully considered when evaluating early ACT research, his attempt to devise an empirical matching strategy by creating a comparison sample of CBT studies to bolster his conclusions was itself problematic. The samples were clearly mismatched in terms of the populations being treated, leading to differences in study design and methodology. Furthermore, reanalysis showed clear differences in grant support favoring CBT compared with ACT studies that were not reported in the original article. Given the actual mismatch between the samples, Öst's methodological ratings are difficult to interpret and provide little useful information beyond what could already be gathered by a qualitative review of ACT study limitations. Such limitations are characteristic of the earlier randomized controlled trials of any emerging psychotherapeutic approach.  相似文献   
46.
A remarkable surge in efforts to assess the quality of life of patients has occurred in recent years in medical research. Philosophical discussions of these developments have focused, on the one hand, on epistemological reservations about the plausibility of measuring quality of life and, on the other hand, on moral and ethical qualms about the meaning of life conveyed in such assessments. Whilst providing an important note of caution, such critiques fail to recognise two basic principles of quality of life in medical research. Firstly it is intended to provide understanding about groups and categories of patients rather than individuals. Secondly the purpose of such research is to produce generalisations about the relative costs and benefits of specific health care interventions rather than absolute judgements regarding the quality of life of patients per se. Selecting a good quality of life measure for a clinical trial requires balancing criteria such as validity with practical feasibility. Such measures will play an increasingly central role in providing research evidence to improve health care.  相似文献   
47.
A probabilistic explication is offered of equipoise and uncertainty in clinical trials. In order to be useful in the justification of clinical trials, equipoise has to be interpreted in terms of overlapping probability distributions of possible treatment outcomes, rather than point estimates representing expectation values. Uncertainty about treatment outcomes is shown to be a necessary but insufficient condition for the ethical defensibility of clinical trials. Additional requirements are proposed for the nature of that uncertainty. The indecisiveness of our criteria for cautious decision-making under uncertainty creates the leeway that makes clinical trials defensible.  相似文献   
48.
The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.  相似文献   
49.
We investigated the effects of group instruction, peer-dyads, and peer-mediated accountability on the number of trials performed and the number of correct trials during one-minute timed trials of volleyball skills. Peer-mediated accountability consisted of teacher goal setting, peer recording of performance, public posting of performance, and special content-related activities that served as public recognition of achievement. Twenty-four students in a Grade 4 physical education class participated. A reversal A-B-A-C design was used to assess the effects of each condition. Results indicated that students performed more trials and were more successful in the peer-mediated accountability condition than during either group instruction of peer dyads conditions. Findings are discussed in terms of the contingent relation between performance and consequences created by the peer-mediated accountability variable.  相似文献   
50.
We measured the effects of two procedures for implementing 1-min time trials on the rate and accuracy with which elementary students wrote answers to single-digit math facts in two concurrent experiments in a first grade classroom and a special education classroom. On-task behavior of three students in each class was also measured. Baseline was a 10-min work period in which students were told to answer as many problems as you can. The two time trial conditions, each of which was also conducted within a 10-min period, consisted of: (1) a series of seven 1-min time trials with a 20-s rest period following each timing; and (2) two 1-min timings, each followed by a teacher-directed feedback and self-correction activity. Students in both classrooms answered correctly more problems per minute during both time trial conditions than they did during the 10-min work period, with the highest levels of fluency occurring during the two time trials with self-correction. The emphasis on going fast did not impair students' accuracy of performance. In both classrooms the percentage of attempted problems answered correctly was high during the initial baseline and increased slightly over the course of the study. On-task behavior was higher during both time trial conditions than during the 10-min work period. When asked at the study's conclusion which of the three methods for practicing math facts (1) helped you learn the most and (2) would you like to do again, the majority of the students in both classrooms chose the time trials followed by feedback and self-correction.  相似文献   
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