临床研究信息公开的伦理原则分析

随着国内企业和研究者发起的临床研究越来越多,达到国际公认的临床研究信息公开伦理原则非常重要。临床研究信息公开包括研究开始前的注册登记以及研究结束后的结果发表及数据公开。文章基于对《赫尔辛基宣言》和《涉及人的生物医学研究国际伦理准则》的文献研究和比较分析,系统地梳理了临床研究信息公开相关伦理原则的发展沿革及最新要求,并对我国目前临床研究信息公开的现状进行分析,以期促进我国临床研究信息公开的发展完善,加强受试者保护并促进临床研究质量提升。     

奥斯勒的生命书写及其叙事意义

叙事具有强大的人文和人际功能,它能促使主体之间更有效地实现认知上的共识。居丧者的哀伤历程和罹患疾病的患者接受自己生病身份的过程是一个需要通过见证、续写或改写故事来重构人生意义的过程。从奥斯勒创设天堂来信帮助作为居丧者和患者的妻子格蕾丝克服心身疾痛这个故事,发现叙事素养能够帮助临床语境下的多方主体之间构建“同声相应,同气相求”的生命共同体关系。从叙事医学的角度而言,医学是一门综合性的艺术。在“医学是不确定的科学与可能性的艺术”的基础上,医学实践可以理解为需要科学技术知识和叙事人文素养合力的“应用型科学和关系性艺术”。     

临床代理决策中的利益冲突及其消解

对于限制/无行为能力患者的医疗决策采取代理决策模式,该模式奠基于社会习俗与习惯法。通常情况下,亲属能够更加准确地评判患者的个人价值取向和医疗决定偏好。但是,基于利益判断的主观性,代理决策中的道德冲突难以避免,其合理性辩护基于代理身份的合法性、“善意”与“患者利益”的标签、制度缺失,对于其批评在于代理者德性基础上的一致性不足。按照解决问题的逻辑进程,规避代理决策中利益冲突的方式有寻求共识的可能、临床伦理咨询与司法介入,其中伦理咨询与司法介入需要依托国家制度设计。     

Exploration of Prelicensed Counselors’ Experiences Prioritizing Information for Clinical Supervision

This qualitative study explored prelicensed counselors’ experiences prioritizing information for clinical supervision. Through phenomenological interviews, 7 counselors seeking licensure discussed how they self‐report salient information to their supervisors. Using interpretative phenomenological analysis, the authors identified 3 themes: (a) learned to maximize supervision based on structure of supervision, (b) influences on decision to present, and (c) rationale for presenting client case. Implications for counselors and supervisors are discussed.     

The Depression Anxiety and Stress Scales: Reference data from a large psychiatric outpatient sample

The published norms for the Depression Anxiety and Stress Scale (DASS) give results for clinical populations that largely fall in the severe to very severe categories. As a result, within this population, the ability to compare the comparative contributions of the underlying emotional components is reduced. The present study presents results from a large general psychiatric outpatient population and provides percentile norms with confidence intervals for both the original DASS and the shorter 21‐item form. It is noted that both forms have high validity but that the correlations between scales are higher than those reported in non‐clinical populations. There was little variation between sexes but some variation of results with age with both younger and older cohorts having lower scores except for the Stress scale where there were higher scores in the older group. There is some evidence of a ceiling effect in the Depression and Stress scales. It was noted that nearly a quarter of patient scores fell within the originally defined normal range suggesting that the DASS would not be a particularly sensitive instrument in its previously reported use as a screening instrument for psychiatric illness.     

Personal attitudes toward time: The relationship between temporal focus,space‐time mappings and real life experiences

What influences how people implicitly associate “past” and “future” with “front” and “back?” Whereas previous research has shown that cultural attitudes toward time play a role in modulating space‐time mappings in people's mental models (de la Fuente, Santiago, Román, Dumitrache & Casasanto, 2014), we investigated real life experiences as potential additional influences on these implicit associations. Participants within the same single culture, who are engaged in different intermediate‐term educational experiences (Study 1), long‐term living experiences (Study 2), and short‐term visiting experiences (Study 3), showed their distinct differences in temporal focus, thereby influencing their implicit spatializations of time. Results across samples suggest that personal attitudes toward time related to real life experiences may influence people's space‐time mappings. The findings we report on shed further light on the high flexibility of human conceptualization system. While culture may exert an important influence on temporal focus, a person's conceptualization of time may be attributed to a culmination of factors.     

Adverse childhood experiences in substance use disorder outpatients of a Lebanese addiction center

Childhood adversities (CAs) are well reviewed in mental health and addiction research internationally. However, these variables have not been studied within the framework of addiction in the Middle East region. The present study reports the prevalence of Childhood Adversities in a sample of outpatients seeking treatment for Substance Use Disorder. We used the Adverse Childhood Experiences – International Questionnaire (ACE-IQ) to map out the prevalence of childhood adversities. The studied population was composed of a clinical outpatient sample that met criteria for substance use disorder (N = 144). Results indicated that almost all the sample reported having experienced at least 1 CA, whereby three quarters of the clinical sample reported experiencing 6 or more adversities. Childhood adversities are highly prevalent in a Lebanese substance use disorder population which raises the need for better screening strategies and more understanding of Adverse Childhood Experiences in this specific population     

So many lifetimes locked inside: reflecting on the use of music and songs to enhance learning through emotional and social connection in Trainee Clinical Psychologists

Music is universal; it can provide a common language that speaks from the heart enabling others to connect with the private felt experiences of others regardless of differences within or between people. This ability to empathise with, and understand, the position of others from differing backgrounds is an important competency within the therapeutic work of Clinical Psychologists. There are many facets to diversity just as there are many facets to music. Diversity in music genres can reflect diversity in people. Indeed, there is music to cater for all tastes, cultural/ethnic backgrounds, gender, age and generations with listening often being guided by individual preferences. In the United Kingdom training to become a Clinical Psychologist consists of a university-based 3-year full time professional research doctorate funded through the National Health Service. Trainees work on placements 3 days a week and attend university for academic and research teaching 2 days a week. As part of the academic programme, Trainees undertake experiential learning through workshops and methods such as Problem-Based Learning (PBL). One of the PBL exercises is based on a typical referral within an Adult Mental Health (AMH) service. For the AMH PBL exercise music is used to enhance trainees’ ability to connect emotionally with the personhood of referrals, consider associated complexities, and to reflect on personal and professional boundaries and reflective practice during training and beyond. This paper reflects on the utility of music and songs to enhance the learning experience.     

“三番式”临床技能教学模式的建立及其在临床医学教学中的应用与思考

传统的临床技能教学存在诸多弊端,从而影响了医学生临床技能的培养及合格医学人才的培养。我们在多年的临床教学实践基础上,构建了临床技能学实践教学平台,创建了“三番式”临床技能教学模式,并将其应用于临床实践教学中,对所取得的显著教学效果进行深入剖析。     

胸腔闭式引流术后感染相关因素的探讨与对策

胸腔闭式引流术是一项有创性操作,多种因素可能会引起胸膜腔及肺内感染。为了预防及处理胸腔闭式引流术后的相关性感染,我们从临床角度讨论更换胸腔闭式引流瓶的间隔时间、胸腔闭式引流管口的消毒、胸腔引流液逆流的预防、胸腔引流管的更换以及由于留置胸腔闭式引流引起的肺内感染的处理等问题,为临床医护人员对该项操作提供参考和对策。