Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has
not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning
about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing
as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination
of the tacit dimension from clinical judgment. This is demonstrated through analyzing the dichotomy between clinical and statistical
intuition in evidence-based medicine’s epistemology of clinical reasoning. I argue that clinical epidemiology presents a more
nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi’s theory of
tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based
medicine.
Objectives: Evidence suggests that disgust responses, known to negatively affect psychological wellbeing, may differ in people with cancer. We performed the first quantitative investigation of three discrete types of disgust trait – disgust propensity, sensitivity and self-directed disgust – in people diagnosed with a broad range of cancers (versus cancer-free controls), and explored their associations with psychological wellbeing.
Design: In a cross-sectional survey design, 107 participants with heterogeneous cancer diagnoses, recruited from cancer charities and support groups, were matched with cancer-free controls by age and gender.
Outcome measures: Measures of the three disgust traits were taken alongside measures of anxiety and depression.
Results: Disgust sensitivity and physical self-disgust were significantly higher in the cancer than control sample, while disgust propensity and behavioural self-disgust were lower. The disgust traits had a different pattern of associations to psychological wellbeing across the two groups, with disgust sensitivity predicting depressive symptoms to a significantly greater extent in the cancer than control group.
Conclusions: People with cancer differ from matched controls in their disgust responses and these responses have significant predictive relationships with aspects of their psychological wellbeing. The results suggest that emotion-based interventions may be useful for improving psychological wellbeing in people with cancer. 相似文献
Breast cancer (BC) patients in China suffered from a variety of psychology stress such as perceived stress and anxiety, posttraumatic growth (PTG) as a positive factor could promote their psychology health and quality of life. This study aimed to investigate the efficacy of mindfulness-based stress reduction (MBSR) on promoting PTG, decreasing perceived stress and anxiety of Chinese BC patients. A randomized controlled trial of 60 BC patients (Stages I–III) was conducted. They were randomly divided to the 8-week MBSR group or usual care (UC) group. PTG inventory, Perceived Stress Scale of Chinese version (CPSS) and State Trait Anxiety Inventory (STAI) evaluated the PTG level, perceived stress and anxiety at three times(before intervention-T1, after intervention-T2 and follow up at 3 months-T3). A repeated-measures analysis of variance model was used to compare each outcome measure of two groups at the three times. There was one patient discontinued the intervention and one lose to follow up in MBSR group, finally 58 BC patients completed the research. There was no difference between two groups before the intervention. The results showed significant improvements in MBSR group comparing with the UC group that PTG level was much higher after the 8-week intervention and the follow up (F = 34.73, p < .00). At the same time, CPSS (F = 14.41, p < .00) and STAI (F = 15.24, p < .00) scores were significant decreased at T2 and T3. The results showed that MBSR promoted the level of PTG and decreased perceived stress and anxiety state of Chinese BC patients, and the results persisted at three months after intervention. The research preliminary proved that MBSR was suitable to Chinese BC patients. MBSR should be recommending to BC survivors in China. 相似文献