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291.
Barbara Wharton 《The Journal of analytical psychology》1998,43(2):205-223
The author addresses the difficulties inherent in reporting clinical material. These fall into two main categories, the ethical problem of upholding confidentiality, and the technical problems which include the definition of analytical data, and the numerous ways in which truth can be distorted in the analytic context. It is advocated that consent be obtained from patients before publishing their material. It is also suggested that clinical reports should contain enough detail of the analytic interaction, including the analyst's thoughts and feelings, to convey the analytic process, and to enable the listener/reader to consider the evidence for himself and to draw his own conclusions. It is concluded that an analyst's anxiety about exposing a patient might obscure an anxiety about exposing himself. 相似文献
292.
Margarete Vollrath Svenn Torgersen Randolf Alns 《Scandinavian journal of psychology》1998,39(1):15-24
The aim of the study was to examine prospectively whether coping mediated the relation between Neuroticism and change in different clinical mental syndromes. Assessments were conducted with 154 former psychiatric outpatients six and seven years after their initial contact with an outpatient clinic. Dispositional coping mediated the relation between Neuroticism and change in four of the nine clinical scales of the Millon Clinical Multiaxial Inventory (MCMI-II) (Millon, 1987). High Neuroticism led to coping strategies of disengagement and the venting of emotions and to a lack of problem-focused coping, which in turn translated into a relative increase on the MCMI-II scales. The mediator model of coping was found to apply to the MCMI-II scales "somatoform disorder’, ‘dysthymia’, ‘alcohol dependence’ and ‘thought disorder’. Results are discussed under the perspective of an integration of the positions of the transactional theory of stress and personality psychology. . 相似文献
293.
Ilana Mittman William R. Crombleholme James R. Green Mitchell S. Golbus 《Journal of genetic counseling》1998,7(1):49-70
Latin and Asian-Pacific immigrants are the fastest growing new-comer groups in the U.S. contributing to 85% of immigration totals. New immigrants experience multiple barriers to accessing genetic counseling resulting from cultural, linguistic, financial, and educational factors as well as having unique perceptions on health, illness, reproduction, and life as a whole. In addition, new immigrants lack familiarity with Western medical practices as well as genetic risk and available interventions. We provided perinatal genetic services to 2430 clients, mostly new immigrants of Latin and Asian-Pacific descent over a period of 6 years. Counseling aides sharing the clients' cultural backgrounds were employed. A study assessing the efficacy of cross-cultural education regarding advanced maternal age risk and amniocentesis was implemented and linked to a database containing demographic and clinical information. Practical observations relating to cultural beliefs in the two groups relevant to perinatal genetic counseling were made. 相似文献
294.
Jeffrey J. Haugaard 《Journal of child and family studies》1998,7(3):377-392
Increased concern about the influence of pregnant women's substance use on fetal health has prompted a variety of actions, including calls for legal interventions against some pregnant women with chronic substance abuse problems. In this paper I examine the legal and social science arguments used to support and oppose these interventions. Several assumptions about the behaviors of pregnant women that are used to support the arguments are described. The types of social science research that could inform the ongoing debate about interventions with pregnant women are explored. 相似文献
295.
Up to now neither the question, whether all theoretical medical knowledge can at least be described as scientific, nor the one how exactly access to the existing scientific and theoretical medical knowledge during clinical problem-solving is made, has been sufficiently answered. Scientific theories play an important role in controlling clinical practice and improving the quality of clinical care in modern medicine on the one hand, and making it vindicable on the other. Therefore, the vagueness of unexplicit interrelations between medicine's stock of knowledge and medical practice appears as a gap in the theoretical concept of modern medicine which can be described as Hiatus theoreticus in the anatomy of medicine. A central intention of the paper is to analyze the role of philosophy of medicine for the clarification of the theoretical basis of medical practice. Clinical relevance and normativity in the sense of modern theory of science are suggested as criteria to establish a differentiation between philosophy of medicine as a primary medical discipline and the application of general philosophy in medicine. 相似文献
296.
A couple presented for genetic counseling because of an elevated maternal serum alpha fetoprotein. Ultrasound examination revealed the presence of a neural tube defect. The couple declined an amniocentesis, but chose serial ultrasound evaluations instead. Ultrasounds eventually identified microcephaly, but the couple continued to decline amniocentesis. After the child's birth, the diagnosis of 5p- syndrome was made. The couple's decision not to have an amniocentesis allowed the family their right to autonomy; however, prenatal chromosome analysis would have provided this couple with a great deal more prognostic information. We discuss the conflict between a counselor's duty to respect a client's freedom vs. duty to care for a client's welfare. We address issues of nondirective counseling and the need for more studies looking at the decision-making process in prenatal diagnosis. 相似文献
297.
Jurrit Bergsma 《Theoretical medicine and bioethics》1994,15(4):361-376
Recent research supports the hypothesis that more active engagement of the patient in occurring illnesses improves quality of life and probably even life expectancy.In this study experience and theoretical knowledge from psychotherapy is transplanted to clinical practice in order to improve the physician's engagement in the patient-disease relationship. By defining severe and long-term illnesses as a psychotrauma, the transfer of the psychotherapeutical model leads to the creation of a new triangular relationship: patient-illness-doctor. Practical examples are used as illustrations for the conceptual differences between psychotherapy and clinical medicine. Options for dialogue show the difference between adaptation (learning to live with) and adjustment (active coping strategies and controlling). The hypothesis is that a better dialogue will reduce illness-related stress, giving the patient better and more effective access to personal psychic and physical support systems. 相似文献
298.
William J. Donnelly 《Theoretical medicine and bioethics》1994,15(2):141-148
Many alternatives or supplements to principalism seek to reconnect medical ethics with the thoughts, feelings, and motivations of the persons directly involved in ethically troublesome situations. This shift of attention, from deeds to doers, from principles to principals, acknowledges the importance of the moral agents involved in the situation — particular practitioners, patients, and families. Taking into account the subjective, lived experience of moral decision-making parallels recent efforts in the teaching of medicine to give the patient's subjectivity — his or her personal experience of being sick or disabled — epistemological parity with scientific medicine's objective, biomedically-oriented view of the person's sickness or disability.Moreover, the shift from principalism to principals signals a growing realization that ethical problems in the profession of medicine are inseparable from its practice. Philosophers and other humanists working in medicine should resist the temptation to institutionalize a professional role as solver of ethical problems, clarifier of values, or mediator of disputes and work instead to help practitioners practice medicine reflectively. 相似文献
299.
300.
Danny Wedding 《Neuropsychology review》1991,2(3):233-239
There is a vast and growing literature in psychology demonstrating the general limits of human judgment and clinical inference. These findings clearly apply in the new specialty of clinical neuropsychology, and there is little empirical research to support the widespread belief that judgmental accuracy correlates substantially with experience, professional stature, or reputation as a neuropsychologist. However, the demand characteristics of expert testimony in the forensic arena may encourage individual neuropsychologists to state or intimate that they have unique or special expertise in understanding brain-behavior relationships, or in predicting outcomes following cerebral insult or injury. These claims will be increasingly difficult to substantiate as attorneys become more conversant with the literature on human judgment. 相似文献