循证医学与个体化治疗的共存和矛盾

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。     

Training Community Members to Serve as Paraprofessionals in an Evidence-Based,Prevention Program for Parents of Preschoolers

Widespread dissemination of evidence-based programs for underserved populations may require non-traditional means of service provision. Collaboration with paraprofessionals from communities that are targeted for intervention holds promise as a delivery strategy that may make programs more accessible and acceptable, especially to parents living in low-income, urban neighborhoods. We describe a paraprofessional training program for individuals living in a community targeted for preventive intervention based on high levels of poverty and community violence. The design and implementation of the training program are described in the context of issues related to the use of paraprofessionals in community-based, preventive interventions with parents of young children. We also provide insight into lessons learned from a feasibility study as well as general guidelines for the development of paraprofessional training programs for delivery of evidence-based programs.     

Reasons for Entering Treatment Reported by Initially Treatment-Resistant Patients with Substance Use Disorders

Many individuals with substance use disorders are resistant to entering formal treatment, despite the negative consequences that plague their own lives and the lives of concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) has been developed as an effective strategy for helping family members who are concerned about the alcohol/drug use of a loved one who refuses to seek treatment. The present study explored reasons and feelings that played a part in these resistant individuals' (identified patients [IPs]) decision to begin treatment. Written statements and feelings of 36 initially treatment-refusing IPs, who were engaged into treatment via their CRAFT-trained CSOs, were examined upon entering treatment. Self-report forms assessed three complementary domains about entering treatment: (1) feelings about coming for treatment, (2) important reasons for entering treatment, and (3) reasons for entering treatment narratives. It was shown that the occurrences of self-reported positive emotions and statements that expressed a positive wish for change outweighed negative feelings and statements. Although conceivably these CRAFT-exposed IPs may have provided different responses than other treatment-seeking populations, the current study's strong IP reports of positive feelings, reasons, and narrative statements regarding treatment entry nonetheless address potential concerns that treatment-refusing IPs might only enter treatment if felt coerced by family members and while experiencing salient negative feelings overall.     

Bridging the Theory-Practice Gap by Getting Even Bolder With the Boulder Model

Cognitive behavioral therapy is an effective treatment for virtually all psychiatric disorders. However, very few patients have access to it and few therapists are trained in the theory and practice of cognitive behavioral therapy. Based on the existing evidence and the articles of this series, the following recommendations are made: (a) all mental health care providers (including Psy.D. and social workers) need to be trained in the practice and theories of empirically supported treatments, specifically cognitive behavioral therapy; (b) clinical practice also needs to be based on theory, not just treatment manuals; and (c) psychological treatments have to move beyond the DSM boundaries.     

Retraction and Revocation in Agent Deliberation Dialogs

We present a generic denotational semantic framework for protocols for dialogs between rational and autonomous agents over action which allows for retraction and revocation of proposals for action. The semantic framework views participants in a deliberation dialog as jointly and incrementally manipulating the contents of shared spaces of action-intention tokens. The framework extends prior work by decoupling the identity of an agent who first articulates a proposal for action from the identity of any agent then empowered to retract or revoke the proposal, thereby permitting proposals, entreaties, commands, promises, etc., to be distinguished semantically.     

借鉴循证医学方法促进SARS治疗决策科学化

面对突如其来的严重急性呼吸综合征(SARS),其预防和治疗方案层出不穷.究竟哪一种预防或治疗方法对SARS最有效?怎样面对现有的困难?如何借鉴循证医学的理念及方法,促进SARS治疗决策科学化至关重要.