循证医学证据的哲学蕴义

循证医学的核心理念是开发利用最佳证据用以指导临床医疗实践。从认识论的角度看,其证据的本质仍然是通过以病人为研究对象的临床医学研究所获得的知识信息,但却是经过分层滤过、系统综合和翻译转化的知识信息,是可以用于提高临床诊断、治疗水平和服务质量的,即可以直接转化为“现实生产力”的可运用的知识信息。     

公正:对待同性恋者的主要伦理原则

同性恋问题由来已久,但至今同性恋者仍处于社会的边缘和弱势地位,提出旨在对这一问题的解决提出公正原则是对待同性恋者的主要伦理原则.通过践行伦理公正,使其获得应有的权利,从而使同性恋者获得合理的地位,实现其做人的价值.     

低位直肠癌保肛手术循证医学证据

低位直肠癌是否行保肛手术的主要依据是病人的全身条件、肿瘤的分化程度、浸润转移的范围以及距齿状线的距离而个体化对待。对于低位直肠癌是否行保肛手术、低位直肠癌保肛手术后是否行结肠贮袋吻合术、直肠癌术前是否新辅助治疗以及是否行腹腔镜低位直肠癌保肛手术,这些方面都需要依据循证医学证据,不能凭个人主观意愿,这样才有助于进一步提高直肠癌的治疗效果。     

循证医学在构建和谐医患关系中的应用

医患关系是一种特殊的人际关系。采用循证医学的原理和方法,规范医疗服务行为,缓解医患矛盾,构建和谐的医患关系,已越来越成为人们的共识。试图从循证医学的角度探索改善医患关系的途径,通过对循证医学理论的应用来缓解医患冲突,改善医患关系。     

Implementation in a Changing Landscape: Provider Experiences During Rapid Scaling of Use of Evidence-Based Treatments

This study examined 133 service providers’ perspectives on a rapid shift to mandated evidence-based treatment delivery, utilizing an inductive coding process to capture themes present in their qualitative feedback. The majority of provider comments were negatively valenced, but attitudes varied considerably across response categories: comments regarding practice context and support were nearly uniformly negative, while comments regarding treatment fit and therapeutic consequences were more balanced. Treatment fit was the most commonly cited category; the fit to therapist (e.g., ease of use) subcategory was predominantly positive in contrast with the fit to client (e.g., flexibility) subcategory, which was predominantly negative. Results illustrate the intended and unintended consequences of large-scale implementation efforts on community providers, and may aid implementation researchers and system decision makers optimize the conditions under which community providers are asked to implement evidence-based treatment.     

Medicalizing tensions in counselor education?

The aim of this paper is to summarize research into the tensions associated with medicalization in graduate counselor education in a primarily Canadian context. Counselor education, until recently, has largely embraced pluralistic traditions of practice that are potentially at odds with a medicalized approach to practice. Medicalization here refers to a diagnostic and treatment focus most commonly associated with use of DSM5 diagnostic procedures and evidence-based treatment. Tensions, in this study, refer to competing accountabilities encountered in reconciling medicalized with other approaches to practice. Following a review of relevant textbooks, graduate program websites and curricula, Master’s-level counseling students, counselor educators, and profession leaders were surveyed and/or interviewed regarding how medicalization influenced counselor education, and for how they responded to its influence. Data across all sources were analyzed using the mapping procedures of Situational Analysis, a method useful in analyzing contested phenomena and processes. We report our findings as navigable, negotiable, and dilemmatic tensions shaping the experiences of students and other stakeholders in counselor education. We recommend ways to enable students and educators to navigate and negotiate potential dilemmas associated with medicalizing influences on counselor education. We close by discussing the implications of our findings with respect to practice and training in the UK context.     

Recognizing Racit Knowledge in Medical Epistemology

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine.An erratum to this article can be found at     

A Broader Perspective: Counseling Psychology’s Emphasis on Evidence

The process of identifying empirically supported treatments developed by the Division 12 of the American Psychological Association has been criticized from various perspectives. However, there are a number of alternative evidence-based models for using research findings to increase the efficacy of mental health services. In this article, the principles of empirically supported interventions developed and adopted by Division 17 (Society of Counseling Psychology) are presented. These principles (a) utilize a broad perspective of evidence, (b) consider a range of psychological interventions, (c) emphasize the quantitative aggregate of research evidence, (d) consider various levels of specificity, and (e) recognize philosophy of science issues that impinge on the types of conclusions that can be made.     

Preparing children to cope with earthquakes: Building emotional competence

Natural disasters, including earthquakes, can have a traumatic impact on children's psychological wellbeing and development. The efficacy of interventions aimed at enhancing children's socio-emotional learning has been documented in the literature. At the same time, these techniques are the key for training children for possible future disasters by enhancing their knowledge about behavioural preparedness and emotional competence. However, research on evidence-based training programs on earthquakes combining digital and traditional activities is scarce. We tested the efficacy of a 10-unit training program for primary school children, developed within the Emotional Prevention and Earthquakes in Primary School (PrEmT) project. The program aimed at increasing knowledge of and metacognition about earthquakes, safety behaviours, emotions, and coping strategies, through digital (using the web-application HEMOT^®, Helmet for EMOTions, developed ad-hoc) and traditional activities (completing paper-and-pencil tasks). The participants were 548 second and fourth-graders from Italian schools. They were divided into an experimental group (participating in the training program) and a control group. Both groups participated in pretests and posttests to evaluate changes in their knowledge of training-related contents. For ethical reasons, we also measured children's wellbeing. Generalized linear mixed models indicated an improvement in the experimental group's knowledge and metacognition about earthquakes, safety behaviours, emotions, and coping strategies after the training program, compared to the control group. Children's general wellbeing did not deteriorate during participation in the project. The results documented the efficacy of the evidence-based training program developed within the PrEmT project. The program provides a preventive method for enhancing earthquake-related resilience that could be generalized to other kinds of disasters.