Effects of diagnostic classification systems on clinical hypothesis-generation

In this study it was determined whether (a) classification as opposed to absence of classification has an effect on the quality of clinical hypotheses (b) the DSM-III-R and the CBCL have a different effect on the quality of clinical hypotheses, and (c) the potential difference between the DSM-III-R and the CBCL is moderated by the different number of syndromes identified by these systems. To investigate these questions, an experiment was conducted in which 86 clinicians generated hypotheses for six cases. The clinicians were divided into a DSM-III-R, a CBCL, and a control group. Of the six cases, two were classified by both classification systems as one syndrome, two were classified as one syndrome by the DSM-III-R but as two syndromes by the CBCL, and two were classified as two syndromes by the DSM-III-R but as one syndrome by the CBCL. The quality of the hypotheses was determined by means of four dependent variables selected from an overview of qualitative criteria: explanatory value, redundancy, possibility of operationalization, and specificity. No differences between the CBCL and the control groups were found. The DSM group performed better than the control group regarding explanatory value and redundancy. The DSM-III-R group also scored better than the CBCL group regarding explanatory value, particularly when the number of identified syndromes was two for the CBCL and one for the DSM-III-R.     

Competing interests: The need to control conflict of interests in biomedical research

Individual and institutional conflict of interests in biomedical research have becomes matters of increasing concern in recent years. In the United States, the growth in relationships — sponsored research agreements, consultancies, memberships on boards, licensing agreements, and equity ownership — between for-profit corporations and research universities and their scientists has made the problem of conflicts, particularly financial conflicts, more acute. Conflicts can interfere with or compromise important principles and obligations of researchers and their institutions, e.g., adherence to accepted research norms, duty of care to patients, and open exchange of information. Disclosure is a key component of a successful conflict policy. Commitments which conflict with a faculty member's primary obligations to teaching, research, administrative responsibilities, or patient care also need attention. Institutional conflict of interests present different problems, some of which are discussed in an analysis of an actual problem posed by two proposed clinical trials. This paper is adapted from a lecture presented to a Symposium on Scientific Integrity, Warsaw, Poland, 23 November 1995. Daniel Steiner was Vice-President and General Counsel of Harvard University (1972–92) and in that capacity became familiar with conflict of interest issues. He is currently Counsel to the Boston law firm. Ropes and Gray, and is Adjunct Lecturer in Public Policy at the John F. Kennedy School of Government. Harvard University.     

A biopsychosocial therapeutic approach in a private outpatient clinic in Portugal

Patients with chronic stress and ambiguous symptoms are likely to be more frequent in primary care. Somatizers represent 75.8% of the patients in this study and executives 56% of the sample. Job stressors were present in 78.3% of executive men. This scenario suggests that the primary care physician has to be academically better prepared to fully understand and deal with stress problems in daily clinical practice. The physician must have skills to deal with stress at a curative and preventive level, extending those skills to the workplace.     

IDENTIFYING THE EDUCATIVE AND SUPPRESSIVE EFFECTS OF POSITIVE PRACTICE AND RESTITUTIONAL OVERCORRECTION

Two major features of the overcorrection procedure, restitution and positive practice, were analyzed for their educative and suppressive properties in the treatment of profoundly retarded adults. Positive practice techniques that were topographically similar and dissimilar to the target behavior were studied. Eating behavior and puzzle performance were observed. Restitutional overcorrection and both forms of positive practice were effective for suppressing inappropriate behaviors. Even when appropriate behaviors had been acquired by positive practice, restitution and dissimilar positive practice were generally ineffective for increasing their rate of occurrence. However, topographically similar positive practice was successful as a means of teaching new appropriate behaviors.     

Reaction times of younger and older men and temporal contingencies of reinforcement

Influences of extended training and temporal contingencies on reaction time were studied in relation to developmental differences. Older and younger men were trained on a chained schedule in which completion of a variable interval produced a terminal link in which reaction time was measured. The reaction-time procedure involved a conditional discrimination with matching to sample in one component and oddity matching in the other. During baseline training, no time limit was placed on the response to the discrimination choice stimuli. Subsequently, increasingly severe time limits were imposed over a series of sessions. Older and younger men showed increased speeds (decreased reaction times) when temporal contingencies were imposed, and these changes were maintained during post-training baseline sessions when there was unlimited time in which to respond. The younger men generally responded faster than the older ones, and age differences were not appreciably reduced during the course of the experiment. The results indicated the feasibility of studying reaction time in human subjects using operant procedures analogous to those developed for the study of nonverbal organisms.     

THE FUNCTIONS OF ASSESSMENT: IMPLICATIONS FOR SELECTION AND DEVELOPMENT OF DEVICES FOR ASSESSING REPERTOIRES IN CLINICAL,EDUCATIONAL, AND OTHER SETTINGS

An attempt is made to identify the many different functions that assessment of an individual's repertoire can serve. Implications of these functions for the character of and evidence about assessment devices are suggested. The functions fall into two general groups, those which influence decisions regarding an individual learner, and those which influence policy, program development, and scientific knowledge. The first group of functions is presented in a rough chronological sequence such that they form a “behavioral assessment funnel,” beginning with functions involving broad-band assessment to identify likely persons and skill areas, and narrowing to the precise pinpointing, monitoring, and follow-up functions. The contribution of behavior analysis and behavior therapy to assessment methodology in this sequence is identified as well as the areas where more traditionally conceived methods are still useful. The second group of functions and behavioral contributions to it are then discussed.     

RELATIVE EFFECTIVENESS OF TEACHER ATTENTION AND THE “GOOD BEHAVIOR GAME” IN MODIFYING DISRUPTIVE CLASSROOM BEHAVIOR1

A variety of behavioral procedures have been employed in recent years to modify disruptive classroom behavior. Such methods have been developed with the belief that curtailing disruptive behavior would strengthen positive classroom performance. In this study, two procedures, the good behavior game and the teacher-attention method, were compared to determine short-run effectiveness. Four teachers (two fourth-grade and two fifth-grade) implemented both methods in their classrooms over a five-week period. Presentation of methods was alternated in a counterbalanced design to control for order effects. Each of the four classrooms consisted of 25 students. A time-sampling procedure was used to record the presence or absence of disruptive behavior within 15-second intervals. Disruptive behavior was defined as any talking-out or out-of-seat behavior without permission. The results indicated that both procedures were effective in modifying disruptive classroom behavior, but that the good behavior game reduced disruptive behavior significantly better than the teacher-attention method. In addition, all teachers preferred the game to the teacher-attention procedure. This reaction seemed related to the effort involved in initiating the two activities. The good behavior game required less effort on the teacher's part. However, use of the game alone raises certain ethical considerations. One such issue involves abuse of peer pressure. Also, there is a possibility that negative rules may tend to promote resentment. Positively stated rules would ameliorate that problem. Another relates to the possibility that some teachers might be carried away by the ease of the game's implementation to the extent that behavior control becomes the primary objective in the classroom. As a result, one might consider use of the game to maximize short-term change, but then phase out this procedure in favor of another method (e.g., teacher attention) for long-run effects.     

Analytic practice: Convergences and divergences1

The author discusses current convergences and divergences concerning analytic practice. After presenting a clinical vignette that can be understood differently according to different theoretical approaches, he discusses Wallerstein’s proposal of a common ground in psychoanalysis and suggests that the present state of the art indicates that psychoanalysis is a pluralistic discipline, with different ways of training and practising it, and that the main challenge is to improve our ability to listen to and to learn from different approaches.     

国内外医学专业杂志发表医学人文相关文章情况分析

总结分析了201 2年1月～2013年5月国外4种医学专业杂志(BMJ、JAMA、LANCET和NEJM)医学人文相关文章的发表情况,并与国内4种知名医学专业杂志(《中华医学杂志》、《中国实用内科杂志》、《中华内科杂志》和《中华外科杂志》)发表的医学人文类文章的情况进行对比分析,结果发现,国外医学专业杂志医学人文类文章比重较大,而且涉及的领域较广,包括医疗卫生政策管理、医学社会学、对患者及医生的人文关怀、医疗风险告知和医疗差错告知的文章.而国内与国外杂志相比存在较大差距.     

家庭社会经济地位对幼儿良好行为习惯的影响:父母教养方式与幼儿心理素质的中介作用

幼儿时期是培养个体良好行为习惯的重要关键期。以814名幼儿及其家长为研究对象,探讨家庭社会经济地位与幼儿良好行为习惯的关系,以及父母教养方式和幼儿心理素质的中介作用。结果表明：（1）家庭社会经济地位与幼儿良好行为习惯显著正相关;（2）父母教养方式与幼儿心理素质在家庭社会经济地位和良好行为习惯间起连续中介作用,且权威型教养方式与心理素质的链式中介作用显著高于专制型教养方式与心理素质的链式中介作用。因此,要促进幼儿养成良好行为习惯,应注重父母教养方式的选择与幼儿心理素质的培养。