Does Evidence-Based Medicine Apply to Psychiatry?

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs.     

认知损伤的评估

该文介绍了作为认知损伤临床评估最优方法的必要条件。评估的一个重要目的是将关于功能区域的优势和劣势的假设公式化,并据此设定适当的康复目标,评价康复的结果。为了达到这一目的,评估应该开始于康复之前,贯穿于康复过程,并持续到康复结束以后。文中比较了两种评估方法：量表法和假设检验法。为了考察认知损伤及其引起的障碍的变化,测验应该具有信度、敏感性和效度。量表法通常不具备这三个必要条件,而假设检验法在这方面更好。该文以一例获得性失语症的词语产出损伤评估为例,介绍了假设检验法的应用     

A group-based treatment for clients with Obsessive Compulsive Disorder (OCD) in a secondary care mental health setting: Integrating new developments within cognitive behavioural interventions – An exploratory study

Aims: This paper presents a model of a group-based intervention for the treatment of clients with Obsessive Compulsive Disorder (OCD) referred to secondary mental health care services, which has been developed by the authors over the last five years. Method: Groups are not a common form of treatment design for this client group, however the available literature is briefly reviewed and the common issues that informed the design are identified. Following this additional technique of neuropsychological theories, Mindfulness, and socialisation are presented and a brief rationale for their inclusion provided. Quantitative and Qualitative outcome measures of the most recent group are discussed with respect to the utility and validity of the model. Conclusion and implications for practice: It is concluded that the group has good ecological as well as outcome validity and provided a method of linking together evidence-based practice (EBP) and practice-based evidence (PBE) movements.     

循证烧伤医学与烧伤医学的发展

循证医学是以证据为基础的医学,其在烧伤医学的应用即为循证烧伤医学。循证医学主要实施策略是发现和提出问题;寻求烧伤医疗实践中或者文献中的有价值证据;进行实验或方法学的评价;应用于临床检验的实践中;评价实践结果。循证烧伤医学和循证医学对烧伤医学的学科发展和临床工作的开展具有重要的意义,烧伤医学今后的发展方向是循证烧伤医学。     

循证医学在ICU中的应用

循证医学(Evidence-Based Medicine,EBM)是指慎重、准确而明智地应用当前所能获得的最佳的研究证据,同时结合医生个人的专业技能和临床经验,并考虑患者的价值和愿望,将三者完美地结合起来制定出对患者最有利的临床决策。然而,ICU中的各项治疗措施常缺乏大规模随机对照试验(RCT)的证据;对于已经实施的RCT同样存在着概念方面的错误,尤其是很多被认为已经RCT验证过的措施实际上并无RCT的证据。尽管如此,但近年来我们终于在临床试验结果方面有了更多积极的进步,一些干预措施已被证明可改善患者的预后。     

循证医学与临床诊断学教育改革

探讨在临床诊断学教育中,导入循证医学的理念和方法,改变传统的经验医学教育模式,实现教学相长。以期提高医学生的理论知识水平和临床技能,提高临床实践能力,培养具有临床循证思维和创新思维的新一代医学人才。     

脂肪细胞因子与2型糖尿病的防治

脂肪细胞因子与2型糖尿病并发症关系密切,随着对胰岛素抵抗(IRS)在2型糖尿病作用的认识,脂肪细胞因子的提出,使2型糖尿病并发症防治观念发生了根本的转变,提出了2型糖尿病并发症关防治新策略:从以降糖治疗为主到全面综合防治。对脂肪细胞因子和脂肪细胞因子与2型糖尿病并发症的关系的认识,体现了循证医学的思想和创新思维的启动。     

Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice

Training in counseling psychology has evolved to emphasize both evidence-based practice (EBP) and social justice, though these two dimensions have often seemed disconnected, or even at odds in the practice of psychotherapy. The Partners for Change Outcome Management System (PCOMS), an EBP that monitors treatment outcomes and the therapeutic alliance across treatment (often called “client feedback”), may offer a means to connect evidence-based and socially just practices. The purpose of this article was to outline how the use of PCOMS in psychotherapy and supervision can serve as a useful training tool that is a form of EBP and also promotes a socially just paradigm in psychotherapy. We also offer an implementation example from a counseling psychology doctoral program to demonstrate how PCOMS can be used with clients in psychotherapy and included within the supervisory process.     

Whose social values? Evaluating Canada’s ‘death of evidence’ controversy

With twentieth- and twenty-first-century philosophy of science’s unfolding acceptance of the nature of scientific inquiry being value-laden, the persistent worry has been that there are no means for legitimate negotiation of the social or non-epistemic values that enter into science. The rejection of the value-free ideal in science has thereby been coupled with the spectres of indiscriminate relativism and bias in scientific inquiry. I challenge this view in the context of recently expressed concerns regarding Canada's death of evidence controversy. The worry, raised by Stathis Psillos, is that as constructivist accounts of science demoted the previously secure status of evidence for drawing justified conclusions in science, we were left with no rational delineation between the right and wrong values for science. The implication for the death of evidence controversy is that we may have no rational grounds for claiming that the Canadian Government is wrong to interfere with scientific enterprise. But he does offer another avenue for reaching the conclusion that the wrong social values are directing the current stifling of some sectors of Canadian science. Psillos draws from standpoint epistemologies to devise a salient defence of ‘valuing evidence’ as a universalizable social value. That is, government bodies ought to enable scientific research via adequate funding as well as political non-interference. In this paper, I counter that (i) non-epistemic values can be rationally evaluated and that (ii) standpoint epistemology’s universalizable standpoint provides an inadequate framework for negotiating social values in science. Regarding (i), I draw from the evidence-based medicine debate in philosophy of medicine and from feminist empiricist investigations into the science–values relationship in order to make the argument for empirically driven value arbitration. If social values can be rationally chosen in the context of justification, then we can have grounds for charging the Canadian leadership with being ‘at war with science’. (ii) I further argue that my recommended empiricist methodology is preferable to Psillos’s search for universalizable perspectives for negotiating social values in science because the latter method permits little more than the trivial conclusion that evidence is valuable to science.     

Democratisation of wellbeing: stakeholder perspectives on policy priorities for improving national wellbeing through paid employment and adult learning

Recent policy initiatives in the UK have heightened the degree to which wellbeing can be considered a political construct: The acceptance of different policy options for wellbeing depends on the extent to which those options are responsive to popular wellbeing concerns. Drawing on the views of over 400 people gathered through a variety of methods and across the UK, we outline different stakeholder views of what wellbeing is and the priorities that stakeholders believe should be addressed to improve wellbeing. We draw out the implications for reframing policy debates around wellbeing, the practice of career guidance, academic debates around identified wellbeing priorities, and the best means of developing a policy and a practice-oriented and stakeholder-responsive approach to researching wellbeing.