Informed consent and the use of placebo in poland: Ethical and legal aspects

The concept of informed consent was one of the most fruitful ideas that deeply changed the relationships between physicians and their patients from paternalism to respect for the personal autonomy of subjects needing professional medical care. The great progress in medicine, also involving the pharmaceutical industry, has created an increasing need to perform different clinical and experimental trials. The evolution of clinical research in the last decades has influenced strongly the design of these studies. One of the most important changes in this field has been the use of placebo groups in double-blind controlled studies. The controversies have involved not only the use of placebo when standard or proven treatment was available, but also some specific problems concerning the procedure of obtaining informed consent in such trials. This paper briefly presents the evolution of informed consent in Poland as well as different ethical and legal problems concerning informed consent and the use of placebo controls in clinical trials. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Response to Difficult Patients in Group Analysis: The Personification of I:A/M

The author focuses on the application of Hopper's proposal of an additional basic assumption (I:A/M) using a model of clinicians' theories: bridging theory, psychological theory, and clinical theory (Michels, 1999). This paper will describe the potential for advances in understanding particular group formations seen in clinical practice and other settings.     

Ethics and engineering courses at Delft University of Technology: Contents, educational setup and experiences

This article reports on the development and teaching of compulsory courses on ethics and engineering at Delft University of Technology (DUT). Attention is paid to the teaching goals, the educational setup and methods, the contents of the courses, involvement of staff from engineering schools, experiences to date, and challenges for the future. The choices made with respect to the development and teaching of the courses are placed within the European and Dutch context and are compared and contrasted with the American situation and experiences. Previous versions of this article were presented at the meeting of the SEFI Working Group on Engineering Ethics in Rzeszow, Poland, April 29–May 1, 1999 and at the SEFI Annual Conference in Zurich, Switzerland, September 1–3, 1999.     

Look Who's Talking: Measuring Self-Disclosure in MFT

While self-disclosure plays a prominent role in the development and maintenance of the therapeutic relationship, most marriage and family therapy clinical research fails to include measures of self-disclosure. A factor analysis of Chelune's (1976) Self Disclosure Situations Survey (SDSS) reduces the number of items in this measure from 20 to six. Researchers are encouraged to consider conducting clinical research with specific attention to the construct of self-disclosure. The revised SDSS could easily be added as part of the self-report information collected in clinical studies.     

现代复苏的药物应用现状的理性思考

回顾了复苏药物应用研究的现状,运用创新思维的科学方法对现代复苏药物临床应用研究中的医学和伦理难题进行了理性分析,阐明了理论,逻辑思维,哲学思考对临床实践和医学研究的重要性。     

Quantitative Anatomy: Power Beyond the Images

Positron emission tomography (PET) is a frontiermedical technology that, in contrast to the othercomputer-assisted technologies providing anatomicalpictures, produces functional images. I argue that PETalso opens up an avenue for shifting from images (asa tool for representation of biomedical data) back toanalysis of measurements (as a tool for quantificationof physiology). Admittedly, quantification of functionrequires structural constraints. I coined the emerginginterpretational framework quantitative anatomyin an attempt to conceptualize the PET merger betweenmeasuring and imaging, the two competing meansmedicine uses to examine the human body. Anatomyjustifies interpretations that fit the existingknowledge of a larger clinical audience, whilestatistical data possess an unexplored potential tointroduce mathematical rigor in the evaluation offunction, but are still a black box for the majorityof clinicians. This epistemological change is beingcarried out by PET users in action as well as indiscourse.     

A case study of behavioral assessment and treatment of insect phobia

We assessed the academic performance of a 14-year-old boy with insect phobia in the context of feared stimuli. The dependent measure was math calculation rate across three conditions that varied therapist statements about the presence of crickets and the actual presence of live crickets. Subsequent treatment consisted of graduated exposure and contingent rewards for math problem completion. Assessment results indicated that the boy's performance was consistently low in the presence of live crickets but not when he was spuriously informed that crickets were present (the primary referral concern). Treatment results indicated no effect from exposure alone and a dramatic effect when exposure was combined with contingent rewards.     

Images of God and the imaginary in the face of loss: a quantitative research on Vietnamese immigrants living in Canada

ABSTRACT

This study examines the relationships between images of God, the imaginary and experiences of loss among Vietnamese immigrants living in Canada. One hundred twenty-nine participants completed four sets of questionnaires: a demographic questionnaire, a Questionnaire on God Image, the Brief Symptom Inventory, the Davidson Trauma Scale. In the second phase, 32 participants were administered the AT.9 test (an archetypal test with nine elements). In this test, participants are asked to draw, using nine symbolic elements, and then write a story based on their drawing. Results showed that a positive perception of God negatively correlated with somatisation, anxiety and hostility, whereas negative God image was significantly related to high levels of emotional distress. Results also showed that the synthetic categories of the imaginary were associated with a positive perception of God; and were negatively associated with somatisation, intrusion and hyper-vigilance. Further discussions on the main findings will address cultural implications in the fields of Mental Health, Religion and Culture.     

Iraqi refugee men’s experiences of psychotherapy: clinical implications and the proposal of a pluralistic model

The psychotherapy experiences of a sample of Iraqi refugee men, in later stages of exile, were explored with the aim of shedding some light on how this client group can experience therapy. Ten adult male Iraqi refugees – who had lived in Sweden for at least five years and had been psychotherapy clients at some point during that time – were recruited for this study. Using individual semi-structured interviews (in Arabic), three main areas were explored with each participant: (1) reasons for seeking psychotherapy; (2) perceptions of the psychotherapy professional; and (3) experiences of the psychotherapy process and outcome. The interviews were then translated into English, transcribed, and then analysed using Interpretative Phenomenological Analysis (IPA). Most participants/clients described exile-related stressors as their main reason for seeking psychotherapy, but some described distress due to a combination of pre-migration trauma and post-migration stress. They also found some aspects of therapy to be positive (mainly verbalising ones thoughts and feelings, and feeling less marginalised) and some negative (mainly experiencing racist or culturally insensitive treatment by therapists, and experiencing a lack of competence and transparency in therapists). The findings were explored in terms of clinical implications and a pluralistic model was proposed to address the identified needs.     

现代姑息医学内涵在实践中的演化

积极开展姑息医学服务已成肿瘤临床工作者的共同实践,并使其在实践中得到发展。姑息医学在肿瘤整体治疗中的作用和地位已逐渐受到同行的认同,提高了肿瘤工作者对姑息医学实践的参与热情,使业内有识之士从全新的角度对姑息医学的内涵进行审视。本文拟结合姑息医学的发展历程及不同分期肿瘤患者姑息治疗的内容介绍现代姑息医学内涵的演化过程。