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.     

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.     

循证医学的辩证思维

随着临床医学的发展,临床医生面临着从理论知识加个人经验的医学模式向以科学证据为基础的医学模式转变。越来越多的卫生政策和诊疗指南的制定需要以高质量的研究结果为依据,如随机对照研究的结果,特别是随机对照研究的系统综述结论。循证医学模式要求医生在临床工作中不断提出问题并通过严格的科研设计来回答这些问题,同时强调不断进行知识更新,掌握最新研究证据以指导其临床工作。同时政府部门也鼓励发展循证医疗,因为它可通过研究有效的诊疗手段来提高卫生保健的效率。此外还有迹象表明法律决策过程中要参考是否遵循了研究证据和临床指南。知情的服务对象也促使临床工作者寻求研究证据作为依据,为了提高服务质量并且充分把握特殊专业领域的现状,临床工作者也需要不断了解新的依据信息。在众多的研究信息中,我们应对每项证据的研究方法、研究对象及观察的终点进行认真分析,确定该结论是否真实并适合我们的实际,从而制定有据可查的诊疗方案。     

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。     

The National Research Council Report on the Prevention of Reading Difficulties in Young Children and the Process of Dubitation

The author examines two significant issues, the adjudication of evidence and the architecture of instruction in the context of research on beginning reading. In particular, he reflects on his participation as a member of the National Research Council's committee that published the recent report entitled Preventing Reading Difficulties in Young Children (1998). The National Academy of Sciences panel of experts process is contrasted with a more explicit process for codifying scientific evidence and including quantitative experimental research as the primary source of evidence. In addition, the author argues for the importance of attending to the architecture of instruction in beginning reading.     

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.     

The Treatment Planning of Experienced Counselors: A Qualitative Examination

Using consensual qualitative research, the authors examined the treatment planning process of experienced counselors (N = 9). The data analysis resulted in 4 domains: assessment steps, clinical impressions, treatment factors, and treatment strategies. These domains describe the process used by experienced counselors in making clinical decisions and offer insight into the nature of clinical expertise and the need for further research on treatment planning.