Negotiating Ethical Paradoxes in Conducting a Randomized Controlled Trial: Aligning Intervention Science with Participatory Values

In this article, we describe ethical tensions we have faced in the context of our work as intervention scientists, where we aim to promote social justice and change systems that impact girls involved in the juvenile legal system. These ethical tensions are, at their core, about resisting collusion with systems of control while simultaneously collaborating with them. Over the course of designing and implementing a randomized controlled trial (RCT) of an ecological advocacy intervention for girls, called ROSES, ethical paradoxes crystalized and prompted us to engage in critical reflection and action toward the aim of moving away from conducting research on legal‐system‐involved girls and moving toward a more democratic, participatory process of inquiry with girls. Our experience revealed two intertwined paradoxes that ultimately served generative purposes. First, in collaborating with legal system stakeholders, we observed a single story of girls’ pathology narrated for girls, without girls, and ultimately internalized by girls. Second, in reflecting critically on the ethical implications of our study design, it became clear that the design was grounded in a medical model of inquiry although the intervention we sought to evaluate was based, in part, on resistance to the medical model. We describe emergent ethical tensions and the solutions we sought, which center on creating counternarratives and counterspaces that leverage, extend, and disrupt our existing RCT. We detail these solutions, focusing on how we restructured our research team to enhance structural competence, shifted the subject of inquiry to include the systems in which youth are embedded, and created new opportunities for former research participants to become co‐researchers through formal roles on an advisory board.     

A cluster randomised controlled trial of an intervention based on the Health Action Process Approach for increasing fruit and vegetable consumption in Iranian adolescents

Objective: To evaluate an intervention programme based on the Health Action Process Approach and designed to increase the intake of fruit and vegetables (F&V) among Iranian adolescents aged 13 to 18.

Design: A randomised controlled trial with three arms examined the short- (1 month) and long-term (6 months) effects of the intervention. There were two intervention groups (one included adolescents only [A group; n = 510]; the second included mothers and adolescents [M + A group; n = 462]) and a control group (n = 483). All participants were recruited from schools.

Main outcome measures: Social cognitions, self-regulatory processes and F&V intake.

Results: The intervention led to an increase in F&V intake for adolescents in the short and long terms. Adolescents in the M + A group increased their F& V intake more than adolescents in the A group. Outcome expectancies, self-monitoring, intentions, action and coping planning, perceived social support and behavioural automaticity mediated the effect of the intervention on F&V intake.

Conclusion: The theory-based intervention led to an increase in F&V intake and promoted more positive social cognitions and self-regulatory processes among Iranian adolescents. The findings also provide evidence that involving mothers in an intervention can confer additional benefit.     

The (In)visibility of Psychodiagnosticians' Expertise

This study investigates decision making in mental health care. Specifically, it compares the diagnostic decision outcomes (i.e., the quality of diagnoses) and the diagnostic decision process (i.e., pre‐decisional information acquisition patterns) of novice and experienced clinical psychologists. Participants' eye movements were recorded while they completed diagnostic tasks, classifying mental disorders. In line with previous research, our findings indicate that diagnosticians' performance is not related to their clinical experience. Eye‐tracking data provide corroborative evidence for this result from the process perspective: experience does not predict changes in cue inspection patterns. For future research into expertise in this domain, it is advisable to track individual differences between clinicians rather than study differences on the group level. Copyright © 2015 John Wiley & Sons, Ltd.     

浅谈神经干细胞在临床应用中的伦理问题

神经干细胞在治疗中枢神经系统退形性病变中发挥重要作用,但在其移植治疗中也面临着一些问题,例如伦理问题及技术问题。如何合理地引导人们正确地认识这项研究,消除对神经干细胞移植治疗的种种误解,使全社会都能客观理性地面对这一新兴医疗技术,看到这一技术的巨大应用前景是我们要继续努力的目标。     

目前形势下临床教学问题的探讨与改革

当前医疗大环境的改变,社会评价的影响及病人的维权、自我保护意识等使临床教学工作发生了很大变化.需要我们采取相应的变革,注重病历的书写,基本功的培训,语言能力的指导和改变查房的方式,以完成培养新一代合格医生的任务.     

关于临床决策问题

医生在临床工作中做出明确诊断,并据此给予有效的处理均属于决策过程。制定决策的整个过程,同时也是进行决策思维的过程。近年来高新技术的迅猛发展以及医疗费用急剧增加,使制定决策更加复杂。如何进行正确的决策思维,做出最切实可行的和最佳的决策,对避免决策的盲目性、局限性及惰性具有重要的现实意义。     

多维视野下的临床决策

临床决策是临床实践的重要组成部分之一,随着时代和科学技术的发展,临床决策的内涵和方法也发生了深刻的变化。有许多的因素影响或决定临床决策的质量,如何正确处理好循证医学证据与经验、传统方法和现代技术、创新与人文主义精神、技术与费用等关系是一个十分复杂的课题,需要从临床、经济、社会和法律等多方面加以研究和探索。     

中西医结合若干问题的比较思考

讨论中西医结合对西医临床思维的影响。对于慢性病中医注意病人的主观症状,与病人就医的缘由一致;西医重视客观的功能和结构异常,其判断结果有时未必能被病人接受。近年来西医开始重视病人的生活质量,其实中医的辨证指标有很多就是针对病人的生活质量。中医的整体观念同样体现在急性感染的治疗中,现代研究显示,清热解毒法除祛邪外也兼顾扶正。中西医结合促进了中西药合用,但须注意合理应用,避免合用的不良效果。