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。     

Resistance as a Problem for Practice and Theory

Resistance is one of the most problematic and potentially counterproductive concepts in the entire field of psychotherapy. It is at the same time one of the most crucial, pointing toward perhaps the single most important factor—or, more accurately, set of factors—in determining the success or failure of the therapeutic enterprise. Drawing on the articles by Davis and Hollon, Prochaska and Prochaska, Reid, and Eagle in this issue, as well as on the author's own perspective, this paper explores this seeming contradiction in order to point toward an integrative resolution of the differing perspectives on resistance and related phenomena.     

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.     

How Do Creative Experts Practice New Skills? Exploratory Practice in Breakdancers

How do expert performers practice as they develop creatively? This study investigated the processes involved in the practice of new skills by expert breakdancers. A great deal of evidence supports the theory of “deliberate practice” (Ericsson, Krampe, & Tesch‐Römer, 1993, Psychological Review, 100, 363) in skill acquisition; however, expert creative performers may emphasize other forms of practice for skill development. Four case studies collected through fieldwork and laboratory observation were analyzed to evaluate expert dancers’ practice processes as they developed proficiency in new, specific skills. We focused on three aspects of learning: the degree of skill acquisition, the content of skills included in practice, and dancers’ stated purposes for practicing. The results showed that dancers’ practice improved skills (as suggested by deliberate practice) and engaged the exploration of new, original skills, along with coordinating skills within performance. In their practice, these dance experts went beyond deliberative practice to highly exploratory processes for skill development.     

Learning Painting Styles: Spacing is Advantageous when it Promotes Discriminative Contrast

Repetitions that are distributed over time benefit long‐term retention more than when massed. Recent research has suggested that the advantage of spacing may extend to induction learning‐‐learners were better able to identify the artists of previously unseen paintings when, during training, artists' paintings were spaced (paintings by different artists were interleaved) rather than massed (a given artist's paintings were blocked and presented consecutively). Increasing temporal spacing between paintings while maintaining a presentation sequence that was blocked by artist produced test performance no better than massed presentation (both worse than interleaved presentation) (Experiment 1). Displaying paintings by different artists simultaneously produced test performance as good as interleaved presentation and better than massed presentation (Experiment 2). Our findings argue that spacing benefits perceptual induction learning not because of increased temporal spacing per se but rather because interleaving paintings by different artists enhances discriminative contrast between the artists' styles. Copyright © 2011 John Wiley & Sons, Ltd.     

Young Indigenous Australians' Sexually Transmitted Infection Prevention Practices: A Community‐based Participatory Research Project

National surveillance data indicate marked differences between Indigenous and other Australians in the prevalence of many sexually transmitted infections (STIs). Young Indigenous people bear a particularly high burden of these infections. A collaboration of university researchers, Indigenous health workers and young Indigenous people conducted 45 field interviews to examine how young Indigenous Australians keep themselves healthy and protected against STIs. Our findings emphasise the complexity of health behaviours, where individuals are rarely always ‘risky’ or always ‘safe’, as well as subtle gender differences in health practices. Preventive strategies employed by the young people were contingent on beliefs and knowledge about sexual partners, the type of relationship, the context of the sexual encounter and access to condoms. Tangible strengths such as young Indigenous people's commitments to condoms and STI screening should be celebrated and bolstered to enhance their ability to protect themselves against adverse health outcomes and enhance their resilience against STIs. Focusing on strengths helps to counter the deficit model of health commonly deployed in Indigenous health research and draws attention to health issues facing young Indigenous people and their communities, without reinforcing negative stereotypes or focusing solely on individual risk behaviour. We provide concrete recommendations for health promotion and education. Copyright © 2011 John Wiley & Sons, Ltd.     

When less is more: Consumer aversion to unused utility

A series of experiments demonstrates that consumers exhibit aversion to waste during forward-looking purchase. These experiments further reveal that such behavior is driven by distaste for unused utility, a reaction that is shown to be distinct from an aversion to squandering money. Waste aversion is especially pronounced when consumers anticipate future consequences and deprivation is salient. In addition to demonstrating robustness across consumers and marketing contexts, the results also demonstrate how waste aversion can lead to self-defeating behavior in which consumers forego desired utility. Finally, the present research demonstrates and discusses the implications of waste aversion for a variety of marketing issues, including buy-rent markets, bundling, and the fundamental distinction between goods and services.     

Post G20: The Challenge of Change,Implementing Evidence‐based Public Order Policing

In the wake of the 2011 ‘riots’, public order policing tactics in England and Wales have once again been brought into question. Yet, the riots came two years since police regulatory authorities in the UK called for fundamental reforms to the policing of public order. Questions are raised about why the change called for appears to have been so slow and what can be done to assist reform. This paper suggests that developing an evidence‐based policing approach within the field of public order policing to inform police decision‐making would provide the answers. By doing so, the paper addresses some of the possible barriers to implementing evidence‐based policing in public order and calls for police academic partnership to overcome these to make ‘change’ an ongoing reality. Copyright © 2012 John Wiley & Sons, Ltd.