From case management to prevention of scientific dishonesty in Denmark

In 1992, The Danish Medical Research Council established a national committee on scientific dishonesty with the twofold task of handling cases of scientific misconduct and taking preventive initiatives. Scientific dishonesty was proven in only five cases, but in another nine cases lesser degrees of deviations from good scientific practice were found. The experiences from a total of 24 treated cases indicated that three key areas were at the basis of most of the accusations and the deviations from good practice: uncertainty about 1) authorship, about 2) rights and duties to use scientific data and about 3) agreements at the initiation of joint studies. As a consequence guidelines on good practice have been issued on these key subjects. An earlier version of this paper was presented at a symposium, Scientific Misconduct. An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998.     

Professional Autonomy and the Normative Structure of Medical Practice

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine.     

The Therapeutic Factors Inventory: Development of a Scale

Although Yalom's (1995) framework of the therapeutic factors facilitating outcome in group has been accepted by group specialists, no empirically based instrument assesses all of these factors. The Therapeutic Factors Inventory (TFI), with 11 scales based on the therapeutic factors, has been designed to fill this gap. This article summarizes the development and preliminary reliability testing of the TFI. Each scale of the instrument demonstrated high internal consistency; however, one scale obtained unacceptably low test-retest reliability. Further validity testing is needed. Implications of these findings are discussed.     

Evidence-Based Psychotherapy and Counselling in the UK: Critique and Alternatives

Developments in empirically supported therapy or evidence-based practice in the UK are outlined and critically examined. Perceived advantages and disadvantages are set out, with a commentary. It is asserted that the evidence-based ethos is seriously flawed and that psychotherapy is essentially a faith-based craft, not a thoroughly researchable scientific enterprise. Some alternatives to evidence-based practice are briefly outlined, before turning to an exploration of the wider context of anthropathology in which therapy takes place and against which it must acknowledge its limitations. Broad-brush conclusions are drawn.     

传统儒家、道家哲学生态观比较

儒家、道家哲学生态观既有共同点,又存在差异。在生态存在论上,两者都是一种生成论世界观,强调人与自然万物的内在联系。不过,道家注重自然运化过程的自然性、一体性,儒家则强调自然运化的生命特征,肯定人与万物的差别;在生态价值论上,道家偏重“自然”的价值．强调自然运化的自然目的性和价值性,肯定人和万物的自然本性的价值。儒家则偏重“人文”价值。它强调人与社会的生存价值．肯定主体德性的价值;在生态实践观上,道家强调“自然无为”的实践原则,“自然无为”体现了对自然自组织、自协调智慧的信任。道家实践观体现在个人生活方式上具有消减性特征,强调慈爱利物、俭啬有度、知和不争。儒家强调发挥人的主体能动性,肯定主体对人与社会、人与自然关系的协调作用。在对农业生产实践的治理上。儒家强调顺应天时、因地制宜和“谨其时禁”。     

Genetic Counseling for Fragile X Syndrome: Updated Recommendations of the National Society of Genetic Counselors

These recommendations describe the minimum standard criteria for genetic counseling and testing of individuals and families with fragile X syndrome, as well as carriers and potential carriers of a fragile X mutation. The original guidelines (published in 2000) have been revised, replacing a stratified pre- and full mutation model of fragile X syndrome with one based on a continuum of gene effects across the full spectrum of FMR1 CGG trinucleotide repeat expansion. This document reviews the molecular genetics of fragile X syndrome, clinical phenotype (including the spectrum of premature ovarian failure and fragile X-associated tremor-ataxia syndrome), indications for genetic testing and interpretation of results, risks of transmission, family planning options, psychosocial issues, and references for professional and patient resources. These recommendations are the opinions of a multicenter working group of genetic counselors with expertise in fragile X syndrome genetic counseling, and they are based on clinical experience, review of pertinent English language articles, and reports of expert committees. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the facts and circumstances of a specific case, will always supersede these recommendations.     

Predictive Genetic Testing for Hereditary Breast and Ovarian Cancer: Psychological Distress and Illness Representations 1 Year Following Disclosure

This prospective study evaluates emotional functioning and illness representations in 68 unaffected women (34 carriers/34 noncarriers) 1 year after predictive testing for BRCA1/2 mutations when offered within a multidisciplinary approach. Carriers had higher subjective risk perception of breast cancer than noncarriers. Carriers who did not have prophylactic oophorectomy had the highest risk perception of ovarian cancer. No differences were found between carriers and noncarriers regarding perceived seriousness and perceived control of breast and ovarian cancer. Mean levels of distress were within normal ranges. Only few women showed an overall pattern of clinically elevated distress. Cancer-specific distress and state-anxiety significantly decreased in noncarriers from pre- to posttest while general distress remained about the same. There were no significant changes in distress in the group of carriers except for ovarian cancer distress which significantly decreased from pre- to posttest. Our study did not reveal adverse effects of predictive testing when offered in the context of a multidisciplinary approach.     

Evaluating Genetic Counseling: Client Expectations,Psychological Adjustment and Satisfaction with Service

Periodic evaluations of genetic counseling services are useful for determining the effectiveness of counseling in meetings its psycho-educational aims, as well as identifying where improvements to the service may be made. This study aimed to evaluate the genetic counseling services provided by Genetic Services of Western Australia (GSWA) to determine the impact of counseling on client expectations, satisfaction with the service, and psychological adjustment, defined as wellbeing and perceived personal control (PPC). A total of 122 clients participated in a self-administered survey conducted pre- and post-counseling. Client expectations of the service as a means of providing information were met, and opportunities for counselors to meet client’s expectations of psychological support were identified. Furthermore, counseling was found to maintain and enhance psychological wellbeing of clients. The role of counseling in facilitating the development of PPC was a key contributor to a high sense of satisfaction in clients.     

鬼谷子的测谎心理思想研究

鬼谷子的测谎心理思想其目的在于帮助统治者考察权变、征召远近人才、谋划国家事物、献说陈情、决安危、定亲疏、察同异、辨真伪。其基本依据的是阴阳观。他认为阴阳是宇宙变化的一贯之道,把握了阴阳之道,就获得了开启人内心隐秘的基本原理。其所遵循的原则是：知己知人原则,隐秘性原则,把握时机原则。其具体技术有捭阖术,即根据阴阳变化原理提出的开启和闭藏的技术;钩言术,即通过语言表达的动静状态窥探他人内心情报的方法;飞箝术,是以激励、褒扬的言语诱导对方获得实情而抓住对方心理的一种测谎技术。揣摩术,又分揣术和摩术。揣术是根据情感的两极变化和惯常行为表现推测对方心理真实情报的方法。摩术是指将内在情感与外在符验相结合进行推测、切磋、体会获得对方真实情报的方法。     

大学生心理压力感量表编制理论及其信、效度研究

本研究在对心理压力感理论维度分析的基础上,编制了大学生心理压力感量表。量表的因素分析结果表明：(1)大学生心理压力主要有两方面,一是个人自身压力包括家庭压力、适应压力、健康压力、恋爱压力、自卑压力和挫折压力：一是社会环境压力包括人际压力、择业压力、情绪压力、学校环境压力和学业压力。(2)通过信、效度检验,大学生心理压力感量表的理论维度结构合理,具有良好的信度,达到心理测量学的相关要求。(3)心理压力感量表的各维度对大学生的心理健康水平具有良好的预测作用,可以作为评估大学生心理压力水平的有效测量工具。