重视临床决策规则 因病施治

临床决策规则作为一种决策的工具日益受到重视和应用,依赖于大量原创性研究或循证医学的证据,旨在通过把临床资料数据的收集、整理和解释的过程标准化,指导选择诊疗手段或路线,降低临床决策中的不确定性,限制或减少不必要的检查和治疗,降低因不必要检查(测)和/或治疗所带来的医疗费用的支出,提高效率,使诊疗最优化,促进患者安全,维持或增进临床的后果。从临床决策规则的概念、存在的条件、研制方法、应用现状和未来发展方向和重点等几个方面加以论述。     

Can CBT Be Effective for Aboriginal Australians? Perspectives of Aboriginal Practitioners Trained in CBT

The objective of the study was to investigate whether high and low intensity versions of cognitive behaviour therapy (CBT) might be an effective therapeutic approach for enhancing the mental health of Aboriginal Australians. Five university‐educated Aboriginal counsellors received in‐depth training in CBT. Over the following year, they used CBT strategies with their clients, and met 10 times as a participatory action research group. The group addressed three key questions: (a) Does CBT appear to be useful for Aboriginal Australians? (b) If so, what elements of CBT are perceived to be effective? (c) What adaptations might be made to CBT to enhance its effectiveness with Aboriginal Australians? The resulting qualitative data were transcribed and analysed. Counsellors perceived CBT to be very useful for their Aboriginal clients and for themselves. They reported that it enhanced their clients' well‐being, their own clinical skills, and their own well‐being, and it reduced burnout. The qualities of CBT that were perceived to be effective were its adaptability, pragmatic here‐and‐now approach, capacity for low‐intensity interventions, safe containing structure, promotion of self‐agency, and valuable techniques. It was suggested that the prime requirement for adaptations to CBT were that they would need to fit different social and cultural contexts.     

类别不确定下的特征推理是基于类别还是基于特征联结

共有3个实验探讨归类不确定情况下的特征推理是基于类别进行还是基于特征联结进行。实验1在中文条件下重复了Verde等人2005的实验,得出了与之相符的结果,这个结果用基于类别的理性模型的设想或者是用基于特征联结的设想都可以解释。实验2考察被试在靶类别的类别特征频次并且特征结合出现频次高低不同的条件下特征推理的情况,实验2的结果表明,高集中与低集中两种条件下特征推理没有显著差异,不符合特征推理是基于类别进行的设想,而与特征推理是基于特征联结进行的设想吻合。实验3进一步考察被试在特征结合出现的总频次并且靶类别中特征结合出现的总频次高低不同的条件下特征推理的情况,结果表明,在高结合条件下进行特征推理要优于在低结合条件,支持了在归类不确定情况下的特征推理是基于特征联结进行的设想。据此可以认为,人们的特征推理是基于特征之间联结的频次进行,而不是基于类别进行     

自身抗体与疾病预测

研究显示,在一些自身免疫性疾病出现临床症状之前,患者血液内就会出现某些自身抗体,检测这些自身抗体可以预测机体日后的患病几率,在疾病的预防和控制等方面具有重要意义。本文将对部分疾病中预示性自身抗体的研究进展及用自身抗体预测疾病的价值和面临的挑战等问题作一综述。     

Child's behaviour in mother–child interaction predicts later emotional and behavioural problems

The aims were to examine the association of maternal or child interactive behaviour with emotional and behavioural problems of the child simultaneously and 3 years later, and to assess whether there is continuity in children's emotional and behavioural symptoms from 2 to 5 years. Sixty‐five 2‐year‐old children with their mothers were videotaped during a feeding situation. Their mothers completed the CBCL at 2 years and when the children were 5. Simultaneously, there were no strong correlations between child's emotional and behavioural problems and maternal or child interactive behaviour. Subsequently, mothers' higher sensitivity and more optimal structuring, as well as child's higher involvement of the mother, were associated with lower levels of child externalizing and total problem scores. Also, less responsive children showed more externalizing symptoms 3 years later. There was continuity of emotional and behavioural problems from 2 to 5 years. Problems in mother–child interaction may predict behavioural problems in the child subsequently. Besides maternal behaviour, it is important to consider the interactive behaviour of the child. Children who are less responsive and who show less involvement of the mother are more likely to subsequently present more externalizing symptoms, and these children should be recognized and treated early. Copyright © 2009 John Wiley & Sons, Ltd.     

初级军官心理选拔的预测性

目的：通过建立院校学员胜任特征及初级军官评价模型,探讨初级军官心理选拔检测系统的预测性。方法：某军校340名男性本科学员入校时完成初级军官心理选拔检测,毕业前进行院校胜任特征评价,对162名学员毕业后1~5年进行部队工作表现追踪评价。结果：中国MBTI-G人格类型测验对院校学员管理能力、影响力、约束力、口头表达、军人气质、人际关系等有较好的预测性,预测符合率72.13%;中国军人明尼苏达个性调查表6项精神障碍维度对情绪稳定性有较好的预测,预测符合率71.90%;院校学员一般能力倾向测验对学业成绩、文字表达、口头表达、人际关系和决策能力等胜任特征也有一定的预测性,预测符合率66.70%;三项测验院校胜任特征总预测符合率达81.70%,部队胜任特征总预测符合率76~87%。结论：为我军初级军官心理选拔提供了实用工具,为提高心理选拔预测准确性提供了科学依据     

Predicting Affective Responses to Unexpected Outcomes

In decisions under uncertainty, decision makers confront two uncertainties: the uncertain linkage between actions and outcomes and the uncertain linkage between these outcomes and his or her affective responses to them. The two studies reported here examine affective responses to expected and unexpected outcomes in various settings. In Study 1, a scenario-based laboratory experiment (N = 149), we examined subjects' predicted responses to a range of outcomes, as a function of how surprising the outcome was. Study 2, a field study (N = 127), involved the expectations of bowlers about their scores in an upcoming game and about their responses to various outcomes at, above, and below expectations. We also measured actual affective reactions after the bowlers had completed their games. Findings suggest that subjects both expect and experience a loss-averse, expectation-based value function broadly of the Prospect Theory type. They also anticipate, and experience, an amplifying effect of outcome surprise, though they underestimate its size. We argue that such underestimation, together with overtight prediction ranges, may expose subjects to much larger affective variation with outcome variability than they anticipate.     

Deterministisches Chaos: Einige Wissenschaftstheoretisch Interessante Aspekte

Deterministic Chaos: Some Interesting Points of View from the Philosophy of Science. A comparatively simple example is used to present some of the main features of deterministic chaos. From the point of view of the philosophy of science, three questions are dealt with: if the equations of motion of chaotic systems are falsifiable in a strict sense; whether experiments on chaotic systems are reproducible; to what extent the development of chaotic systems is predictable. It emerges that in these respects chaotic systems, though being deterministic, behave essentially in the same way as stochastic (indeterministic) systems do.