浅析当前临床科学决策的几个影响因素

随着循证医学在我国的发展和"医疗举证责任倒置"等相关法律的实施,我国临床医生在进行诊治决策时已逐步向临床科学决策迈进。而防御性医疗、不健全的医疗制度及相关法律等却严重影响着这一科学决策的转变过程。只有有效解决了导致干扰科学决策的各种社会影响因素,如扩大基本医疗保险的覆盖率,实施医疗风险保险制度,提高医务人员认知和职业素质,保障行医安全等,临床科学决策的真正落实就大有希望。     

行为决策理论之父：纪念Edwards教授2周年忌辰

著名心理学家W ard Edwards对行为决策的学科形成与理论发展作出了巨大贡献。文章简要介绍了Edwards的生平,以主观期望效用模型和贝叶斯决策为核心回顾了Edwards的决策理论、主要成就及其对行为决策研究的学术贡献。文章并从行为决策领域的研究、科普、应用及人才培养等方面总结了中国行为决策研究的发展历程,以及Edwards的学术思想对中国行为决策研究的主要影响。文章展望了行为决策研究的前景,并呼吁更多的中国心理学工作者投身于行为决策研究。     

Results of an Intervention for Individuals and Families with <Emphasis Type="Italic">BRCA</Emphasis> Mutations: A Model for Providing Medical Updates and Psychosocial Support Following Genetic Testing

Providing medical management updates and long-term support to families with hereditary cancer syndromes in rural areas is a challenge. To address this, we designed a one-day retreat for BRCA1/2 carriers in our region. The retreat included educational updates about medical management, genetic privacy and discrimination, and addressed psychological and family issues. Evaluations completed at the conclusion of the retreat were overwhelmingly positive with requests for a similar event in the future. The impact of this retreat on a variety of health behaviors was assessed. Eligible participants completed questionnaires before and 6 months after the retreat. Questionnaires focused on lifestyle, cancer screening and prevention practices, psychological history and distress, decision-making regarding genetic testing, and family communication issues. For individuals who completed both the pre and post retreat questionnaires, one-half made lifestyle changes and nearly two-thirds increased cancer screening, initiated chemoprevention, completed or planned to complete preventative surgery in the future. We conclude that this type of forum provides a valuable opportunity for BRCA carriers and their families to receive updated medical information, share personal experiences, provide and receive support, as well as change health behaviors.     

情绪对职业决策的影响

职业决策是决策研究领域的重要课题,引起了心理学家和决策研究者的高度关注.本文在以往研究的基础上,引人情绪和职业种类变量探讨了情绪对职业决策的影响,结果显示:(1)无论是四种还是八种职业决策任务,积极情绪的被试同消极情绪的被试相比,信息搜索的时间较长,信息搜索的深度显著增加;(2)在职业选择策略上,积极情绪的被试更加倾向于基于选项的加工,而消极情绪的被试随着从四种职业决策任务到八种决策任务的转变,逐渐倾向于基于属性的加工;(3)情绪影响了决策者职业决策的信息加工能力.     

I felt low and my purse feels light: depleting mood regulation attempts affect risk decision making

We propose that negative affect can induce people to engage in risky decisions. We test two alternative hypotheses as to how this effect may emerge. The mood repair hypothesis states that risky choices in risk decision making serve as a means to repair one's negative affect. The depletion hypothesis, in contrast, states that risky choices in risk decision making are the mere consequence of a state of depletion resulting from engagement in active mood regulation attempts. The results of a first laboratory study establish a link between risky choices in risk decision making and negative affect. Subsequent experiments provide evidence that depletion due to active mood regulation attempts, rather than mood repair, is the underlying process for this link. Copyright © 2008 John Wiley & Sons, Ltd.     

异维A酸组和维胺酯组治疗痤疮的比较

为了比较分析异维A酸组和维胺酯组治疗痤疮的临床疗效、费用和不良反应,于服药前后观察疗效、不良反应和相关费用。结果显示,异维A酸组治疗痤疮起效快。在治疗中度痤疮,两组总体疗效、医疗费用相当,但维胺酯组不良反应较轻。而在治疗重度痤疮方面,异维A酸组临床疗效较维胺酯组高,且医疗成本较低。     

临床决策的立场——医学、医院、医生还是病人？

医学的原理应该是决策的依据,但亦应视病人的具体情况而定。医生的兴趣如果只在新技术上、医院的立场如放在经济利益上,必将损害病人的利益。病人希望治愈疾病、安全、节省和希望参与决策是合理的,医生应该站在病人的立场上并帮助病人合理决策。     

医疗决策的程序公正

由于社会满足不了所有的医疗需求,医疗决策问题变成了确定医疗的限度问题。由于社会对于限度决定很难获得共识,医疗决策要通过公正的程序获得。医疗决策不能由某个人或某个团体或权力机构做出,而应该通过民主协商来做出,否则,人们会质疑医疗决策的合法性。     

ALZHEIMER'S DISEASE AND SOCIALLY EXTENDED MENTATION

Abstract: The leading accounts of the ethics of proxy decision making implicitly draw on internalist conceptions of the philosophy of mind, or so this essay tries to demonstrate. Using the views of Ronald Dworkin as its jumping-off point, the essay argues that accepting the sort of externalism associated with writers such as Putnam and Burge would alter Dworkin's conclusions concerning how we should respond to the current or precedent decisions of people suffering from dementia. Building on the views of Agnieszka Jawarska, it argues that accepting "active" externalism à la Clark and Chambers would provide currently competent people with new resources for establishing the authority of their present values over inconsistent values they might come to entertain should they become demented.     

Trait anger and anger expression style in children's risky decisions

In this study, 104 children completed a task, measuring risk decision-making, and the State-Trait Anger Expression Inventory for Children and Adolescents. Subjects were also asked to evaluate the degree of danger, benefit, fun and fear perceived for each risky choice. Analyses indicated that (a) risk decision-making was predicted by both trait anger and outward expression of anger; (b) appraisal of danger fully mediated the relationship between trait anger and risk; (c) perceptions of benefit, scare and fun partially mediated the relationship between trait anger and risk; and (d) appraisal of danger partially mediated the relationship between outward expression of anger and risk decision-making. The results provide evidence for a relationship between dispositional anger and risk decision-making during childhood, suggesting a possible explanation of the mechanisms below. In particular, risk decision-making can be viewed as the output of cognitive and emotive processes, linked to dispositional anger that leads children to be amused, optimistic and fearless in potentially risky situations. These findings substantiate the importance of incorporating cognitive and emotive factors in theories that seek to explain the relationship between personality traits and risk decision-making across a broad age range.