Implications of evidence-based practice for community health

Evidence-based practice, developed in clinical medicine, is being applied to community health programs. Barriers to implementation of evidence-based practice noted in clinical medicine are likely to exist in community health settings and may be complicated by the nature of community health programs. These barriers include accessibility and availability of relevant data, social and political considerations of program decision-making, and conflicting expectations for evaluation research. This paper discusses barriers to both amassing evidence for practice and using evidence for decision-making in community health. The potential for conflict between practice goals set by evidence-based thinking and those set by community health organizations is also discussed. Implications for evaluations of community health programs are raised and recommendations for improving access to and use of evaluation information are made.     

Conflicts of interest in science and medicine: the physician's perspective

The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of conflict of interest that can arise in the practice of medicine are outlined. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The World Medical Association (WMA) is a global federation of National Medical Associations representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavours to achieve the highest possible standards of medical care, ethics, education and health-related human rights for all people.     

A Work in Progress

After expressing gratitude to each contributor, and briefly commenting on each, I probe several main themes of my work, addressing the question of the apparent difference between my earlier philosophical and later clinical writings. Central to both is the reflexivity of the human agent, and that each exhibits a form of practice regardless of the specific aims embedded in each. I then address the theme of narrative writing as my work has developed over the past several decades – at the heart of which are questions of self and integrity.     

The Use of Communication Technology in Private Practice: Ethical Implications and Boundary Dilemmas in Therapy

This study investigates the use of communication technology (CT) by therapists in private practice. CT has exploded in the last decade and therapists have begun to implement this technology in their work. It is important to understand better the types of technology therapists are using and how they decide which devices are most useful for clinical practice. Additionally, the availability of the therapist has long been debated and CT provides media to make therapists readily available. Results show that therapists have boundary concerns and ethical dilemmas regarding CT and often feel unprepared to handle inappropriate out-of-session contacts when they occur.     

The Cleveland Scale for Activities of Daily Living (CSADL): Its Reliability and Validity

This study evaluated the reliability and validity of the Cleveland Scale for Activities of Daily Living (CSADL), a scale designed to measure in detail specific activities of daily living in individuals with dementia. Administered to knowledgeable informants by trained examiners, the CSADL demonstrated good reliability in terms of interrater agreement and internal consistency. The validity of CSADL total scores was shown by its sensitivity to degree of cognitive impairment: All comparisons between means of the healthy elderly group and three groups of AD patients differing in severity were statistically significant. The CSADL was highly correlated with the Blessed–Roth Dementia Scale (DS-ADL) and more highly correlated with Mini-Mental State Exam scores than was the DS-ADL.     

The structure of and changes to the life values of Japanese consumers

As the standard of living improves and the number of choices expands, consumer behavior shifts from meeting needs to realizing the specific life values of each consumer. A structural analysis of life values was performed to increase understanding of consumer behavior as a whole, so that effective marketing strategies can be prepared. The structural analysis of life values was conducted by plotting daily activities in an evaluation space, which was defined by "necessity,""attractiveness," and "ease of achievement," and also by factor analysis of these daily activities. Using this method, we measured the structure of the daily activities of Japanese consumers, and then examined the value structure of time-consuming activities, which our research suggests will be considered highly attractive in the future. Based on the results of the surveys, we discuss the development of the market for highly attractive activities and products. However, an improvement in life infrastructure is a prerequisite to realizing a market for highly attractive activities and products.     

耳畸形及缺损修复发展的历史回顾

耳整形是耳鼻喉手术中最具挑战的技术之一。本文从耳廓畸形及缺损修复材料,修复技术两方面综述了耳整形修复的发展。其中快速原形及组织工程技术应用于耳廓畸形及缺损修复是机械学、材料学与生物医学相互交叉互相渗透,共同发展的结果。这两种技术为耳廓修复整形提供了光明的前景,也是目前此领域科学研究的热点。但是新的理论和技术应用于临床还需要经历缓慢的实践与发展过程。     

中医整体观念对推拿临床的指导意义及其应用举隅

从中医对人体疾病的认识、诊断与治疗三个方面,就中医整体观念对推拿临床的指导意义加以探讨,并举例说明中医整体观念在推拿治疗颈椎病、腰椎间盘突出症、骶骼关节损伤错位所引起的痛经等疾病中的具体运用,旨在引起推拿同仁在推拿临床中对中医整体观念的重视。     

“三阶梯”止痛原则临床实践20年

WHO癌痛“三阶梯”止痛原则发布20年来,经过医患双方上亿人次的临床实践,取得了巨大成功。人类对癌性疼痛乃至良性疼痛的认识,从来没有如此深刻;有关止痛的实践也从来没有如此广泛。作者回顾了“三阶梯”原则的产生背景和历史功绩,指出了“三阶梯”原则在实践中丰富和发展的必要性。作者建议,今后我国癌症止痛应“临床勇于实践,用药讲究技巧,工作重点下移”。     

实践社区成员的面子意识对知识传播的影响

为研究中国人面子意识是否影响实践社区及其成员的知识传播过程,采用自编实践社区成员面子意识问卷以及知识传播过程与效果问卷对重庆、银川、南京和上海等地企业的430名实践社区成员进行测量。结果表明:问卷具有良好的信度和效度;男性的面子意识显著高于女性;工作年限为11~15年的被试"面子—能力学识"得分显著高于其他组别;"面子—人际交往"对"投入程度"、"区外获取"及"传播效果"的预测作用都为正向,而"面子—能力学识"对这三项的预测作用均为负向;"面子—人际交往"和"面子—能力学识"是面子的两个独立维度。