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骨质疏松症和细胞因子关系的新思考 总被引：2，自引：0，他引：2
在骨质疏松症患者体内,细胞因子的改变和雌激素减少是骨质疏松症发生、发展的启动因素,造成骨的代谢紊乱,致使骨吸收超过骨形成,出现骨重建平衡失调与骨转换加快。细胞因子的提出使骨质疏松症防治观念发生了根本的转变,提出了骨质疏松症防治新策略,对细胞因子与骨质疏松症的关系的认识,体现了循证医学的思想和创新思维的启动。 相似文献
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循证医学时代安慰剂的再认识 总被引：1，自引：0，他引：1
安慰剂的治疗作用早已被人们认识,但是对于其在医学上的应用却一直存在争议。在循证医学兴起的今天,我们应该如何辩证地看待安慰剂的作用及不足,以及在临床试验中应该如何应用安慰剂是一个值得探讨的问题。 相似文献
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基于默会知识的循证医学耗散结构观 总被引：1，自引：0，他引：1
阐述了循证医学的理论核心——最佳证据实质是一种默会知识,并指出应当把最佳证据视为一种默会知识,循证医学就会形成一种耗散结构。提出利用耗散结构理论显化默会知识寻找最佳证据的动力学规律和方法论。 相似文献
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循证医学与个体化治疗的共存和矛盾 总被引：4，自引：1，他引：3
施红光 《医学与哲学(人文社会医学版)》2007,28(1):3-4
从人体个体差异的绝对性出发,论述了个体化治疗与循证医学共存的必然性及两者之间的矛盾。循证医学的结论可通过对大量个体化治疗病例的循证研究而不断刷新,从而更好地指导个体化治疗,这是解决两者矛盾的途径。 相似文献
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Paul Healy 《欧洲心理治疗、咨询与健康杂志》2017,19(3):231-251
Although the dominant scientist–practitioner model has considerable professional support, it remains the case that there is a fundamental mismatch between its conceptualisation of the practitioner as a laboratory scientist in a clinical setting and the actual requirements for good counselling practice. In particular, there is mismatch between the kind of knowledge generated in the laboratory setting and the epistemic requirements of the therapeutic situation; and between the (detached, impersonal) kind of decision-making engaged in by the laboratory scientist and the (interpersonal, interactive) kind engaged in by the practitioner. Moreover, being structural in character, these limitations cannot be rectified by piecemeal modifications of the standard model, such as those envisaged on the ‘local clinical scientist model’. Nor can the recent push towards ‘evidence-based practice’ suffice as a corrective because the core problem simply replicates itself on that level. Instead, since they derive from an unduly restrictive conception of what constitutes scientific inquiry, they require endorsement of the equal partnership of the human science template as a corrective. Moreover, far from compromising its scientific commitments, this actively facilitates rethinking the integration of science and practice in the service of the effective practice of care. 相似文献
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John Lees 《欧洲心理治疗、咨询与健康杂志》2017,19(2):141-157
In recent years the counselling and psychotherapy profession has experienced significant changes. On the one hand there has been the advent of managed care and evidence based practice which in the UK takes the form of the Improved Access to Psychological Therapy scheme. On the other hand there has, during the same period since the 1980s, been a rich and varied process of innovation in the profession. This has included the so-called relational inter subjective turn in the United States. Second, an increased sensitivity to the interface between therapy and social and political phenomena. Third, the revolution in neuroscientific thinking. Finally, the development of therapy as an interdisciplinary intervention in complementary and alternative medicine teams as in the case of the spiritually-orientated anthroposophic psychotherapy in Europe. In this article I will argue that these innovatory developments, which I refer to as the ‘new integration’, are much needed in order to counterbalance the increasing dominance of managed care and evidence based practice. 相似文献
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Cognitive behavioral therapy (CBT) has a strong evidence base for several psychiatric disorders, however, it may be argued that currently there is no overall agreement on what counts as ‘CBT’. One reason is that CBT is commonly perceived as encompassing a broad range of treatments, from purely cognitive to purely behavioral, making it difficult to arrive at a clear definition. The purpose of the present study was to explore practicing therapists’ perceptions of CBT. Three hundred fifty members of two multi-disciplinary interest groups for CBT in Sweden participated. Mean age was 46 years, 68% were females, 63% psychologists and mean number of years of professional experience was 12 years. Participants completed a web-based survey including items covering various aspects of CBT practice. Overall, therapist perceptions of the extent to which different treatment techniques and procedures were consistent with CBT were in line with current evidence-based CBT protocols and practice guidelines, as were therapists’ application of the techniques and procedures in their own practice. A majority of participants (78%) agreed that quality of life or level of functioning were the most important outcome measures for evaluating treatment success. Eighty percent of therapists believed that training in CBT at a basic level was a requirement for practicing CBT. There was a medium size Spearman correlation of rs=.46 between the perceived importance of research to practice and the extent to which participants kept themselves updated on research. Implications for training, quality assurance, and the effectiveness of CBT in clinical practice are discussed. 相似文献
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《Cognitive and behavioral practice》2022,29(4):874-882
Clinicians in naturalistic settings regularly modify the delivery of trauma-focused treatments to enhance client engagement and retention. However, what types of modifications are made in clinical settings, why, and when, and their impact on client outcomes has seldom been examined. As an initial step to address this, the current study applied elements of the updated Framework for Reporting Adaptations and Modifications—Expanded (FRAME; Wilstey Stirman et al., 2019) to examine content-level modifications documented in the delivery of posttraumatic stress disorder (PTSD) treatment to veterans via medical records review in an urban PTSD clinic. Results indicated that the updated FRAME suited the data well, and that modifications occurred in most veteran–clinician pairs over the course of treatment. The four most common modifications documented were spreading (27%), repeating (24%), drift with return (22%), and integrating (21%). Three composite case examples are discussed that describe the application of the most common modifications observed in medical record documentation. This is an important first step toward understanding the real-world modifications of evidence-based trauma-focused interventions that in turn will lead to critical recommendations for improving treatment implementation. 相似文献