谈合理用药的相对性

合理或不合理用药是相对的,在临床工作中不能绝对化。首先,合理用药的目的是相对的,安全、有效、经济很难完全满足。其次,合理用药要求的内容是相对的,对于一个具体患者,药物治疗要符合病情、患者和药学的全部特点并非易事。再者,判断合理用药与否的主要依据(如临床资料、临床试验结果等)的可靠性或可信性也不是绝对的。最后必须指出,合理用药的结果受到诸多因素的影响,不一定理想,不一定令人满意。在临床工作中,应尽可能避免不合理用药,若无法避免,可先评估得失和权衡利弊,然后做出科学决策,并加强药学监护和医患沟通。     

Modeling the Structure of the Attitudes and Belief Scale 2 using CFA and Bifactor Approaches: Toward the Development of an Abbreviated Version

The Attitudes and Belief Scale-2 (ABS-2: DiGiuseppe, Leaf, Exner, & Robin, 1988. The development of a measure of rational/irrational thinking. Paper presented at the World Congress of Behavior Therapy, Edinburg, Scotland.) is a 72-item self-report measure of evaluative rational and irrational beliefs widely used in Rational Emotive Behavior Therapy research contexts. However, little psychometric evidence exists regarding the measure's underlying factor structure. Furthermore, given the length of the ABS-2 there is a need for an abbreviated version that can be administered when there are time demands on the researcher, such as in clinical settings. This study sought to examine a series of theoretical models hypothesized to represent the latent structure of the ABS-2 within an alternative models framework using traditional confirmatory factor analysis as well as utilizing a bifactor modeling approach. Furthermore, this study also sought to develop a psychometrically sound abbreviated version of the ABS-2. Three hundred and thirteen (N = 313) active emergency service personnel completed the ABS-2. Results indicated that for each model, the application of bifactor modeling procedures improved model fit statistics, and a novel eight-factor intercorrelated solution was identified as the best fitting model of the ABS-2. However, the observed fit indices failed to satisfy commonly accepted standards. A 24-item abbreviated version was thus constructed and an intercorrelated eight-factor solution yielded satisfactory model fit statistics. Current results support the use of a bifactor modeling approach to determining the factor structure of the ABS-2. Furthermore, results provide empirical support for the psychometric properties of the newly developed abbreviated version.     

Locke's theory of reflection

This paper examines the nature of ‘reasonable’ (eulogos) argumentation in Generation of Animals III.10. Its aim is to develop an alternative to the dialectical construal of reasonable argumentation in Aristotle recently favoured by Robert Bolton. On the basis of a close textual analysis I show that the reasonable arguments deployed in Generation of Animals III.10 do not appeal to endoxa or reputable beliefs per se. Instead, they rely upon general facts (sumbainonta) about animals established by empirical induction. This implies that, contra Bolton, not all reasonable arguments in Aristotle are dialectical; some, in fact, are thoroughly empirical and scientific. I conclude by suggesting that such empirical reasonable arguments even have a place in the De Caelo, the treatise that Bolton primarily focused upon when developing his interpretation.     

临床药师问诊与实践体会

问诊是临床医师的基本技能之一.医师通过问诊可以获得病史资料,从而做出临床决策.随着医学模式从传统的生物医学模式向生物心理社会医学模式转变和临床药学的蓬勃发展,药学服务模式从传统的以保障药品供应为中心向以患者为中心模式转变.药师从药房逐步走向临床,参与合理用药和提供药学服务,问诊也应成为临床药师的基本技能之一.本文通过笔者问诊实践,阐述问诊对于临床药师的重要性、药师问诊的内容及其与医生问诊的区别.     

Habitual Virtuous Actions and Automaticity

Dual process theorists in psychology maintain that the mind’s workings can be explained in terms of conscious or controlled processes and automatic processes. Automatic processes are largely nonconscious, that is, triggered by environmental stimuli without the agent’s conscious awareness or deliberation. Automaticity researchers contend that even higher level habitual social behaviors can be nonconsciously primed. This article brings work on automaticity to bear on our understanding of habitual virtuous actions. After examining a recent intuitive account of habitual actions and habitual virtuous actions, the author offers her own explanation in terms of goal-dependent automaticity. This form of automaticity provides an account of habitual virtuous actions that explains the sense in which these actions are rational, that is, done for reasons. Habitual virtuous actions are rational in the sense of being purposive or goal-directed and are essentially linked with the agent’s psychological states. Unlike deliberative virtuous actions, the agent’s reasons for habitual virtuous actions are not present to her conscious awareness at the time of acting.

On the Emotional Character of Trust

Trustful interaction serves the interests of those involved. Thus, one could reason that trust itself may be analyzed as part of rational, goaloriented action. In contrast, common sense tells us that trust is an emotion and is, therefore, independent of rational deliberation to some extent. I will argue that we are right in trusting our common sense. My argument is conceptual in nature, referring to the common distinction between trust and pure reliance. An emotional attitude may be understood as some general pattern in the way the world or some part of the world is perceived by an individual. Trust may be characterized by such a pattern. I shall focus on two central features of a trusting attitude. First, trust involves a participant attitude (Strawson) toward the person being trusted. Second, a situation of trust is perceived by a trusting person as one in which shared values or norms motivate both his own actions as well as those of the person being trusted. As an emotional attitude, trust is, to some extent, independent of objective information. It determines what a trusting person will believe and how various outcomes are evaluated. Hence, trust is quite different from rational belief and the problem with trust is not adequately met in minimizing risk by supplying extensive information or some mechanism of sanctioning. Trust is an attitude that enables us to cope with risk in a certain way. If we want to promote trustful interaction, we must form our institutions in ways that allow individuals to experience their interest and values as shared and, thus, to develop a trusting attitude.     

The Perspective of Islamic Fundamentalists and the Limits of Rational Choice Theory

How can we best understand Islamic fundamentalism? As fundamentalism has become an increasingly significant political force, many different interpretations have been offered, with fundamentalism explained as both a rational reaction against modernity and as a pathological retreat from reality. We argue here that part of the scholarly failure to understand and deal with the growth of religious fundamentalism results from a failure to recognize the importance of cognitive differences in worldviews held by fundamentalists. By providing an empirical analysis of how fundamentalists see the world—what we identify as a fundamentalist perspective—we hope to supply an important missing piece in the literature on fundamentalism. To do so, we utilized a narrative and survey interview technique to contrast the worldviews of fundamentalists with those of comparable Muslims who are not fundamentalists. Our analysis suggests Islamic fundamentalism attracts because it provides a basic identity, an identity which in turn provides the foundation for daily living. The fundamentalist perspective itself is best understood through reference to a worldview which makes no distinction between public and private, in which truth is revealed by revelation, and reason is subservient to religious doctrine. Religious dictates dominate on all basic issues, and only within the confines of the fundamentalist identity are choices decided by a cost/benefit calculus.     

Multicategorical spline model for item response theory

Additional information contained in incorrect responses calls for a multicategorical rather than a binary analysis of multiple choice data. A nonparametric divided-by-total model for joint maximum likelihood estimation of probability-of-choice functions (for particular responses) and of latent ability is proposed. The model approximates probability functions by rational splines. Some illustrative examples of real test data analysis and the results of a Monte Carlo study are presented.The research in this paper was supported by the National Sciences and Engineering Research Council of Canada Grants OGP0105521 and APA 320 awarded to the first and the second author, respectively. The authors are indebted to R. Melzack and A. Baker for making available the data analyzed in this paper. We would also like to thank J. McKenna and B. Cont for their assistance in editing this paper.     

A stochastic multidimensional unfolding approach for representing phased decision outcomes

This paper presents a stochastic multidimensional unfolding (MDU) procedure to spatially represent individual differences in phased or sequential decision processes. The specific application or scenario to be discussed involves the area of consumer psychology where consumers form judgments sequentially in their awareness, consideration, and choice set compositions in a phased or sequential manner as more information about the alternative brands in a designated product/service class are collected. A brief review of the consumer psychology literature on these nested congnitive sets as stages in phased decision making is provided. The technical details of the proposed model, maximum likelihood estimation framework, and algorithm are then discussed. A small scale Monte Carlo analysis is presented to demonstrate estimation proficiency and the appropriateness of the proposed model selection heuristic. An application of the methodology to capture awareness, consideration, and choice sets in graduate school applicants is presented. Finally, directions for future research and other potential applications are given.     

Practical Reason and the Stability Standard

Practical reasoning, reasoning about what to do, is a very familiar activity. When we think about whether to cook or to go out for dinner, to buy a house or rent, or to study law or business, we are engaged in practical reasoning. If the kind of reasoning we engage in is truly a rational process, there must be some norms or standards that govern it; the process cannot be arbitrary or random. In this paper I argue that one of the standards that governs practical reasoning is the stability standard. The stability standard, I argue, is a norm that is constitutive of practical reasoning: insofar as we do not take violations of this norm to be relevant considerations, we do not count as engaged in reasoning at all. Furthermore, I argue that it is a standard we can explicitly employ in order to deliberate about our ends or desires themselves. Importantly, this standard will not require that some ends are prescribed or determined by reason alone. The stability standard, therefore, allows us to retain some of the attractive features of instrumentalism without accepting the implication that there is no rational way to evaluate ends.