医务人员对医患共同决策辅助工具的态度研究

循证医学实践要求在临床决策中整合最佳临床研究证据、医者经验、患者自身价值取向与所处具体临床情境。使用决策辅助工具进行医患共同决策可作为一种实践模式,有必要了解来自临床一线医务人员的态度。采用多阶段分层抽样方法,于国内11省及3个直辖市共32个城市的51所二级和三级医院发放问卷,探究使用决策辅助工具促进共同决策实施的可能性。对1 212份问卷的分析显示,73.2%的医务人员认可患者是高质量临床决策的参与主体;支持患者获知诊疗决策依据、认同患者决策辅助工具的积极效果与高学历等正相关。     

医患共享决策的价值意蕴、影响因素及辅助工具

当今社会,受消费行为和人权意识的影响,患者愈发渴望参与到医疗决策的过程之中。医患共享决策体现了对患者自主权的尊重,并有助于提高医疗服务品质。然而我国的医患共享决策起步较晚,面对的困难复杂且多样,需要克服来自患方、医方,以及医疗决策过程本身等方面的因素。患者与医生的有效沟通,是提高患者的就医体验,真正实现以患者为中心的使然。在其他国家的实践经验中,决策辅助工具为实现共享决策提供了有益的参考,但现有的决策辅助工具尚不完善,尤其缺乏适合我国国情的决策工具。     

Development of a Communication Aid to Facilitate Risk Communication in Consultations with Unaffected Women from High Risk Breast Cancer Families: A Pilot Study

The literature on risk perception in women from high-risk breast cancer families reveals persistent over-estimation of risk, even after counseling. In this study, a communication aid was designed to facilitate discussion of risk between clinical geneticists and genetic counselors and women from this high-risk population. Method: Stage 1. The aid was developed by an expert panel of clinical geneticists, genetic counselors, psychologists, an epidemiologist, an oncologist, linguists and a consumer. It was guided by the international literature on risk communication and a large multi-centre Australian study of risk communication. The 13 page full-color communication aid used varying formats of words, numbers, graphs and pie-charts to address (a) the woman’s subjective risk; (b) the population risk of breast cancer; c) the risk of inherited breast cancer; (d) the cumulative risk for women with BRCA1 and BRCA2 mutations; (e) family risk factors; (f) the woman’s suitability for genetic testing; (h) screening and management recommendations, and (i) a re-assessment of the woman’s subjective risk. Stage 2: A before–after pilot study of 38 women who were unaffected with breast cancer and were attending four Australian familial cancer clinics was undertaken. Baseline and follow-up questionnaires were completed by 27 women. Outcomes were compared to those observed in 107 similar women undergoing genetic counseling without the communication aid in 2001. Results: The risk communication aid appears to be beneficial; breast cancer genetics knowledge improved in some areas and importantly, risk perceptions improved in the cohort receiving the communication aid. Psychological measures showed no difference in anxiety or depression between the group receiving the communication aid and the comparison cohort. Women and clinicians were very positive about the usefulness of the communication aid as an adjunct to the genetic counseling consultation.     

APPLICANT REACTIONS TO PRE-EMPLOYMENT APPLICATION BLANKS: A LEGAL AND PROCEDURAL JUSTICE PERSPECTIVE

The current research investigated applicant reactions derived from common application blanks. Previous work has found applications to be riddled with legally inadvisable items, but limited research has attempted to understand how such items might affect applicants. By using organizational justice theory as a framework, two studies examined applicant reactions from two application blanks: a legally advisable application and a legally problematic application. It was found that applicants completing the legally problematic application had lower perceptions of justice and expressed higher litigation intentions compared to those completing the legally advisable application, especially for those that were rejected without an explanation.

Remuneration disparities in Oceania: Papua New Guinea and Solomon Islands

This paper explores the impact of remuneration differences on workers in the Solomon Islands and Papua New Guinea. In these countries remunerative differences are linked to government policy (in Papua New Guinea) and job contracts (in the Solomon Islands), and have impacted on industrial relations in both settings (strike action). A total of N = 350 professionals (n = 60 expatriates) from 54 organizations in aid, government, higher education and industry (mean response rate = 36%) responded to an organizational survey form. Remuneration ratios between international and local respondents based on the World Bank's index of purchasing power parity approached 9:1. In both sites staff compared pay and benefits (remuneration) packages: Internationally remunerated staff rated their ability higher than their local counterparts did; locally remunerated groups reported more injustice in remuneration, were more demotivated by the gaps, and were more likely to be thinking about leaving the organization. In-country workshops of N = 40 largely local stakeholders from aid and community organizations plus government ministries considered the survey's findings and recommended: in Solomon Islands, (a) introducing a policy of localization, (b) establishing a remuneration commission (already existent in Papua New Guinea), and (c) reducing the remunerative gap; in Papua New Guinea, (d) reversing the post-Independence "dual pay system" (currently official policy), (e) instituting pay-for-performance, and (f) ensuring the existent localization policy is applied to recruitment, selection, and staff career planning and management.     

人体器官买卖成因和对策的法学思考

器官供需严重不平衡导致了人体器官买卖的产生,器官买卖对供体和受体均存在潜在风险,对社会危险性也不容忽视.分析了器官买卖链条中供体、受体和中介各自的角色和地位,并提出了立法推动尸体器官捐献、加强医院和医务人员承担的法律责任、打击买卖中介和加强网络监管等建议.     

The Role of Government and Lobbying in the Creation of a Health Profession: The Legal Foundations of Counseling

The state and federal governments, along with private industry, play an important role in the development of a health profession. State governments establish training standards through licensure laws, and state programs dictate employment and payment opportunities. The federal government unifies a profession through recognition in national health care programs. Private industry provides public access through private health insurance. The counseling profession has spent decades opening these federal, state, and private programs to become an established health profession.     

Psychobiography in psychology: Past,present, and future

The present article reviews the history and emerging trends in the field of psychobiography. Five historical periods are highlighted: hagiography and pre-19th century study of lives; Freud and applied psychoanalysis; psychodynamic extensions and personology; modern multi-theoretical models; and psychobiography as interdisciplinary science. The author advocates for a science of psychobiography manifested in expanded and empirically validated theoretical models anchoring research. Further, attention is drawn to the need for more rigorous historiographic research methods weighting first-person sources and incorporating mixed methods designs. Increased attention to ethical and legal issues in the conduct and reporting of psychobiographical studies is also highlighted. Finally, emerging trends in psychobiography related to research production, academic training, and organisational initiatives are presented.     

Victim Recantation in Child Sexual Abuse Cases

Summary

This article explores the reasons for victim recantation in child sexual abuse cases, problems that surface with a recantation, and practical steps multidisciplinary professionals can take to prevent the recantation of truthful allegations. Secondly, the article discusses the roles of investigative team members in the investigation and evaluation of a victim's recantation and in the trial which may follow. Finally, the article addresses possible final outcomes of criminal court intervention and the team's role in continued support for the child.     

Requirements and Implementation of Maintaining Patient Records

Summary

This article will discuss the need for psychotherapists to document the statements of patients, the techniques they use, and other aspects of their work to avoid ethical and legal problems. Elements of session notes and written informed consent will be identified. No informed consent can legitimize some actions and they will be addressed.