Managing financial conflicts of interest in clinical research

Upholding public trust in clinical research necessitates that human subjects be protected from avoidable harm and that the design, interpretation and reporting of research results be shielded from avoidable bias. On both counts, managing financial conflicts of interest is critically important, especially in the modern era when the opportunities for investigators to benefit personally from the commercialization of their intellectual property are overtly encouraged and rapidly expanding. Efforts are underway in the United States to provide more useful guidance to universities and medical schools for purposes of strengthening the oversight and management of financial conflicts of interest in clinical research. 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.     

Everyday value conflicts and integrative complexity of thought

This study examined the value pluralism model in everyday value conflicts, and the effect of issue context on complexity of thought. According to the cognitive manager model we hypothesized that respondents would obtain a higher level of integrative complexity on personal issues that on professional and general issues. We also explored the relations of integrative complexity to value priorities, measured by the Schwartz Value Survey, and to emotional empathy. The value pluralism model was not supported by the data collected from 126 university students from social science, business and technology. The cognitive manager model was partially confirmed by data from females but not from males. Concerning value priorities, more complex respondents had higher regard for self-transcendence values, and less complex respondents for self-enhancement values Emotional empathy was also significantly related to complexity score.     

Work–family conflicts,cognitive appraisal,and burnout: Testing the mediation effect with structural equation modelling

Work–family conflict constitutes an important source of occupational stress predicting teachers’ burnout, and cognitive variables have shown to be core structures in explaining human adaptation to stress. Nevertheless, the role of cognitive appraisal needs to be fully analysed to comprehend how it can mediate the relationship between stress and burnout. In order to understand the potential mediation of cognitive appraisal in the relationship between stress and burnout, we adopted conceptual models of stress that highlighted the value of cognitive appraisal on positive and negative reactions to work demands. Also, we analysed the potential moderation of sex and age in the relationship between work–family conflict, cognitive appraisal, and burnout due to inconsistent findings on how these personal variables can interfere on these relations. In this study, we used structural equation modelling (SEM) to test the mediating of cognitive appraisal in the relationship between work–family conflicts and burnout. A survey with measures of work–family conflicts, cognitive appraisal, and burnout was administered to the participants consisting of 438 Portuguese teachers from kindergarten through high school, aged between 28 and 67 years (M = 46.85; SD = 7.88), 304 of whom were females (69.41%). The results confirmed that cognitive appraisal partially mediated the relationship between work–family conflict and burnout. The mediation effect of cognitive appraisal on the relationship between work–family conflict and burnout was invariant regardless of teachers’ sex or age. In sum, cognitive appraisal should be considered in order to understand teachers’ adaptation to work.     

Emotional eating and cognitive conflicts as predictors of binge eating disorder in patients with obesity

Background/Objectives: Binge Eating Disorder (BED) is often associated with obesity. In order to identify the variables that allow to better detect the presence of BED, people with overnutrition were compared with and without BED in the presence of cognitive conflicts, eating symptoms and anxious-depressive symptoms. The inclusion of cognitive conflicts had been relevant in bulimia studies but had not been investigated with respect to BED. Method: Two groups with obesity were evaluated, one without BED (OB, n = 54) and the other with BED (OB-BED, n = 48), using a social-demographic questionnaire as well as a semi-structured interview to assess BED, questionnaires (DASS-21, EDE-Q, EEQ) and the Repertory Grid Technique. Results: Overall, the OB-BED group presented more conflicts and more symptoms. The model that best differentiated between the groups included emotional eating and level of cognitive conflicts, correctly classifying 91.4% of the sample. Conclusion: These results highlight the role played by cognitive conflicts and emotional eating as differentiating elements between OB and OB-BED, with a high level of predictive accuracy.     

患者亲属——医疗决策的重要主体

在医患关系中,患者亲属起着重要作用,是医疗行为及后果生理和心理的承担者,患者的疾病本身和康复情况会直接对家庭生活产生影响。患者亲属也是患者医疗费用的主要承担者。由于医疗决策会涉及到患者的家庭利益,患者患病会对其决定能力产生不利的影响,在法律上确立患者亲属在医患关系中的主体地位,甚至在必要时赋予亲属医疗决定权是必要的和现实的。     

NLP简快心理治疗方法的模式整合及其优势

随着目前医患关系日趋紧张的状况,构建和谐的医患关系成为急诊科医生面临的一个重要课题。从救死扶伤为灵魂、有效解除患者痛苦、尊重和理解患者、良好的医患沟通、语言艺术为桥梁等不同角度深入探讨了急诊科医生如何构建和谐的医患关系。     

医患关系不和谐的原因

由于政府监管部门的缺位与越位导致医疗市场混乱,医疗资源配置不合理与效率低下,医院为了自身利益而鼓励医务人员多收费,医务人员成了给钱治病的经济人,再加上舆论的推波助澜,社会保障体系不健全,以及医疗需求的刚性,医患间的信息不对称,患者对医疗预期值超越了当今的科技水平,导致医患矛盾越演越烈。     

防范医疗纠纷的载体建设——天津市人民医院投诉中心的绩效浅析

利用现代医学伦理的人本理念,将投诉中心作为防范医疗纠纷的载体,有效地解决就医者的投诉接待和处理,无疑是一种全新的理念和尝试。通过对投诉制度建设、投诉处理标准化流程、有效投诉信息的利用等方面的经验性论述,阐明了投诉中心的载体建设,为减少医疗纠纷、加强伦理道德建设、构建和谐的医患关系产生了积极的作用。     

A National Survey of Genetic Counselors’ Personal Values

Personal values are motivational sources for an individual’s actions [Hitlin and Piliavin (Annual Review of Sociology 30:359–393, 2004)]. Genetic counselors’ values may influence their behaviors in clinical practice, but a profile of their personal values has not been identified empirically. In this study, 292 genetic counselors completed the Schwartz Universal Values Questionnaire (SUVQ; Schwartz, S. H. (1992). Universals in the content and structure of values: Theoretical advances and empirical tests in 20 countries. In M. Zanna (Ed.), Advances in experimental social psychology (pp. 1–65). Boston, MA: Academic.), a widely used measure of value types, and provided information about their demographic characteristics. Results indicate that respondents highly valued benevolence, self-direction, achievement, and universalism indicating a strong pattern of concern for the welfare of others. They placed considerably less value on stimulation, tradition, and power, which reflect personal interests. Respondents who reported practicing a religion scored significantly lower on stimulation and hedonism and higher on tradition and spirituality than those not practicing; married respondents and parents scored significantly lower on stimulation and achievement; and males scored higher on power than females. The value types are described, and training and research recommendations are provided.     

Intervenir en clinique de l’activité sur la qualité du travail dans l’organisation. Le cas du service de propreté d’une grande collectivité

This article aims to inform the intervention process and the institution of conflictuality around the criteria on quality of work in an Activity Clinic perspective. From the example of a recent intervention in sanitary service of a big city, this article instructs this process when the conflictuality around the criteria of quality of work can be instituted in the organization. When field professionals can do more authority on their activity in the organization, we then witness in action a modification of their role in decision process, regarding their own work. The article concludes with the contribution of the results produced to current reflections on the union work actuality.