临床决策支持系统应用中的伦理思考

基于人工智能技术的临床决策支持系统(clinical decision support system, CDSS)是可以辅助临床医护人员进行医疗决策的交互式系统。基于知识库和非知识库的两种形式和临床应用情况逐步被熟知。CDSS意在通过解决目前医疗资源不足、配置不合理和标准化治疗不规范等问题提高医疗质量,但也面临着医疗信任、诊断准确性、诊断标准、责任归属等潜在挑战。在CDSS研发与应用中,只有秉持以患者为中心的理念,提高CDSS安全性、明确其诊断标准,才能提升信任基础,从而真正回归临床并提高患者福利。

     

论安宁疗护患者知情同意权

安宁疗护试点所强调的患者“充分知情、自愿选择”是患者知情同意权的体现。患者与家属权利冲突持续存在,知情同意权行使还有医疗伦理及技术上的困难。患者知情同意具有明显人格属性,保护的是患者身体利益,属身体权。安宁疗护应遵循“告知后同意”规则。医务人员告知应以患者知情为优先,采具体病患标准说,并以“预期生存期6个月以内”为进入安宁疗护标准。当患者决定权与社会公共利益相冲突时,应以公益性为原则;法定情形下让位于近亲属决定权;患者通过预先医疗指示行使决定权的,被委任的家属依据委托规则行使代理决定权。

     

社会支持、主动反刍与创伤后成长的关系:基于汶川地震后青少年的追踪研究

本文以追踪研究的方式,在汶川地震后3.5年、4.5年和5.5年三个时间点,采用社会支持问卷、反刍问卷和创伤后成长问卷对汶川地震后245名中学生进行调查。通过建立交叉滞后模型,考察社会支持、主动反刍与创伤后成长的相互作用关系。结果发现,震后3.5年至5.5年间,社会支持对主动反刍和PTG的跨时间点预测作用不显著;主动反刍对PTG具有显著的跨时间点正向预测作用,但对社会支持的跨时间点预测作用不显著;震后3.5年的PTG对震后4.5年的主动反刍具有显著的跨时间点正向预测作用,但震后4.5年的PTG对震后5.5年的主动反刍的跨时间点预测作用不显著;震后3.5年和4.5年的PTG分别对震后4.5年和5.5年的社会支持的跨时间预测作用均不显著。     

父母支持、友谊质量对孤独感和抑郁的影响：检验一个间接效应模型

以560名5、7、10年级学生为被试, 检验父母支持、友谊质量与孤独感、抑郁的关系是否符合间接效应模型及其模型适用性问题。结构方程建模及群组分析结果发现：(1)总体上, 间接效应模型成立, 父母支持既直接影响孤独感和抑郁, 也通过影响友谊质量进而影响孤独感和抑郁状况; (2)从具体适应问题看, 间接效应模型对于孤独感和抑郁均显著, 但更适用于对孤独感的预测; (3)从发展阶段看, 间接效应模型仅适用于童年晚期和青少年早期, 且更适用于童年晚期; (4)从性别角度看, 间接效应模型对两性均显著, 但更适用于男生。结果提示, 父母支持、友谊质量对孤独感和抑郁的影响均符合间接效应模型, 但该模型的适用性可能因具体适应问题、发展阶段和性别而有差异。     

学习支持对基于计算机模拟的发现学习的影响

研究了针对发现活动的意义性的解释性支持 (IS)、针对其系统逻辑性的实验性支持 (ES)以及学习者的推理能力对基于模拟的科学发现学习的影响。设计开发了关于浮力的模拟软件 ,被试为北京十四中初二学生 80名 ,采用 2 (有 /无IS)× 2 (有 /无ES)× 3(推理能力 )的混合实验设计。结果发现 ,推理能力在原理性知识、直觉性理解测验以及学习者所设计实验的质量上有显著的主效应。IS在原理性知识和灵活应用测验上有显著的主效应。ES与推理能力在原理性知识测验上有显著的交互作用 ,ES在学习者所设计实验的质量上有显著的主效应。这一结果说明 ,发现活动的意义性和系统逻辑性对基于模拟的发现学习有重要的制约作用 ,应该针对这两个侧面设计相应的学习支持     

Individual differences in visuospatial working memory: benefits from environmental support for rehearsal

ABSTRACT

Previous research has suggested that participants with low working memory spans are less likely than those with high spans to engage in rehearsal and other effective strategies during memory tasks. However, most of this research has been conducted in the verbal domain, and less is known about strategy differences in visuospatial working memory. Therefore, the present experiments investigated potential individual differences in the benefit participants receive from environmental support for visuospatial rehearsal. In Experiment 1, memory spans were significantly larger when support was present (i.e. when the array of possible locations remained on the screen) during long inter-item intervals, but importantly, the observed benefit was larger for high-span participants than low-span participants, suggesting that high spans were more likely to use support to facilitate their rehearsal. Other research has suggested that low spans may benefit more than high spans from rehearsal instructions, and so in Experiment 2, participants also were provided with such instructions. However, the rehearsal instructions did not improve memory spans significantly in either group, suggesting that low spans are not only naturally less strategic than high spans, but they may be less capable of taking advantage of effective rehearsal strategies, even when environmental support is present.     

Bereavement,received social support,and anxiety in the elderly: A longitudinal analysis

Abstract

Determinants of anxiety and life satisfaction were examined among the elderly. Study I related the experience of stressful loss events, i.e., the death of a friend or family member, as well as received social support, to anxiety. Support buffered the effects of life events: Only those who received no support after loss were highly anxious. Study II explored determinants of anxiety and life satisfaction over a twelvemonth period. About half of the criterion variance could be explained. Perceived health turned out to be an influential predictor, whereas the role of social support remained ambiguous. The results are discussed in terms of social factors and emotions in the life of the elderly.     

Family support,family stress,and suicidal ideation in a combat-exposed sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans

Background and Objectives: Deployment-related risk factors for suicidal ideation among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans have received a great deal of attention. Studies show that mental health symptoms mediate the association between most deployment stressors and suicidal ideation; however, family-related factors during deployment are largely unexplored. We examined posttraumatic stress disorder (PTSD) and depression symptoms as mediators of the associations between deployment family support and stress and post-deployment suicidal ideation in combat-exposed OEF/OIF veterans. Design: National cross-sectional mail survey. Methods: 1046 veterans responded to the survey. The sample for this study was 978 veterans who experienced combat. Regression-based path analyses were conducted. Results: Family support and stress had direct associations with suicidal ideation. When PTSD and depression symptoms were examined as mediators of these associations, results revealed significant indirect paths through these symptoms. Conclusions: This study contributes to the literature on suicidal ideation risk factors among OEF/OIF veterans. Deployment family support and family stress are associated with suicidal ideation; however these associations occur primarily through mental health symptomatology, consistent with findings observed for other deployment factors. This research supports ongoing efforts to treat mental health symptomatology as a means of suicide prevention.     

Professional burnout

Abstract

Stress has been a ubiquitous concept in health research. We compare stress theories with the operationalization of stress in health research. Although scientific investigation is ideally based on theoretical principles, stress research is seen as often atheoretical or misapplying theories. Major conceptualizations of stress are considered and prominent research avenues in health psychology are analyzed as to the extent they mirror, diverge from, or inform stress conceptualizations. A central conclusion of the paper is that perceived and objective stressors are not only both valid construels of stress, but that they operate differently on psychological and physiological systems.