从医师的视角浅析医疗差错的辩证观

医疗差错是影响医疗安全的最重要因素。有效预防和正确处理医疗差错,需要以科学辩证的认识为前提。当前,我国医院管理实践在一定程度上缺乏对医疗差错的辩证认识,导致在处理上存在些许不足。本文从医师的视角,对如何辩证地认识医疗差错进行浅述。指出,医疗差错在相当程度上源于人的出错之天性和医学的复杂性,广泛存在于医疗实践中,发生具有必然性;虽然从表象上看,医疗差错的原因是局部的,但其本质的原因是系统性的;医疗差错是医疗安全系统运行状况的"指示灯",有助于及时地了解安全系统的薄弱环节,为完善和提升系统安全、提高医疗服务水平提供契机。     

Behavior analysis and decision making

Behavior analysts have developed powerful methodologies to assess central phenomena in areas that have been dominated by cognitive psychologists. Advances in instructional control, stimulus equivalence, choice, rule-governed behavior, matching to sample, and verbal behavior are some of the tools that have been developed in the experimental analysis of behavior. Although the article focuses on the experimental analysis of reasoning, this is but one of the areas in which behavior analysts should have a greater impact on contemporary psychology.     

Epistemology shmepistemology: moral error theory and epistemic expressivism

Some philosophers object to moral error theory by arguing that there a parity between moral and epistemic normativity. They maintain that moral and epistemic error theory stand or fall together, that epistemic error theory falls, and that moral error theory thus falls too. This paper offers a response to this objection on behalf of moral error theorists. I defend the view that moral and epistemic error theory do not stand or fall together by arguing that moral error theory can be sustained alongside epistemic expressivism. This unusual combination of theories can be underpinned by differences in the foundational norms that guide moral and epistemic inquiry. I conclude that the problem of epistemic normativity fails to show that it is compulsory for us to reject moral error theory.     

Monothematic delusion: A case of innocence from experience

Empiricists about monothematic delusion formation agree that anomalous experience is a factor in the formation of these attitudes, but disagree markedly on which further factors (if any) need to be specified. I argue that epistemic innocence may be a unifying feature of monothematic delusions, insofar as a judgment of epistemic innocence to this class of attitudes is one that opposing empiricist accounts can make. The notion of epistemic innocence allows us to tell a richer story when investigating the epistemic status of monothematic delusions, one which resists the trade-off view of pragmatic benefits and epistemic costs. Though monothematic delusions are often characterized by appeal to their epistemic costs, they can play a positive epistemic role, and this is a surprising conclusion on which, so I argue, all empiricists can agree. Thus, I show that all empiricists have the notion of epistemic innocence at their disposal.     

Tool use in neurodegenerative diseases: Planning or technical reasoning?

Recent works showed that tool use can be impaired in stroke patients because of either planning or technical reasoning deficits, but these two hypotheses have not yet been compared in the field of neurodegenerative diseases. The aim of this study was to address the relationships between real tool use, mechanical problem‐solving, and planning skills in patients with Alzheimer's disease (AD, n = 32), semantic dementia (SD, n = 16), and corticobasal syndrome (CBS, n = 9). Patients were asked to select and use ten common tools, to solve three mechanical problems, and to complete the Tower of London test. Motor function and episodic memory were controlled using the Purdue Pegboard Test and the BEC96 questionnaire, respectively. A data‐transformation method was applied to avoid ceiling effects, and single‐case analysis was performed based on raw scores and completion time. All groups demonstrated either impaired or slowed tool use. Planning deficits were found only in the AD group. Mechanical problem‐solving deficits were observed only in the AD and CBS groups. Performance in the Tower of London test was the best predictor of tool use skills in the AD group, suggesting these patients had general rather than mechanical problem‐solving deficits. Episodic memory seemed to play little role in performance. Motor dysfunction tended to be associated with tool use skills in CBS patients, while tool use disorders are interpreted as a consequence of the semantic loss in SD in line with previous works. These findings may encourage caregivers to set up disease‐centred interventions.     

Episodic storage and retrieval in visuo-spatial tasks: evidence of indirect retrieval

Episodic storage contends that the relevant target and irrelevant distractor features of a display are processed and then stored together within the boundaries of an episode, and are linked in this way. Accordingly, the selective and “direct” retrieval of either a stored target or distractor should result in the “indirect” and unintended retrieval of the other stimulus. In the present investigation, interest focused upon spatial tasks and the “indirect” retrieval of prime distractor processing. The novel findings obtained supported the existence of the “indirect” retrieval of prime distractor processing in visuo-spatial tasks and, to a lesser extent, of the stored prime target event, consistent with identity tasks (i.e. bi-directional episodically-based retrieval). Clearly, more is retrieved than is presented (Hintzman, D. L. (1984). MINERVA 2: A simulation model of human memory. Behavior Research Methods, Instruments, & Computers, 16, 96–101. doi:10.3758/BF03202365), as an episodic storage structure would predict.     

Examining the Relation Between Technical and Global Competence in Two Treatments for Youth Anxiety

Although technical (quality of delivering techniques from a specific treatment) and global (general clinical expertise) competence are believed to be important ingredients of successful psychosocial treatment with youth, there have been few empirical efforts to measure both dimensions. Efforts to understand the role that each competence dimension plays in the process and outcome of youth treatment starts with determining whether the dimensions can be measured separately. This study examined whether scores from measures designed to assess technical and global competence were distinct. Treatment sessions (N = 603) from 38 youths (M age = 9.84 years, SD = 1.65; 60.5% White; 52.6% male) treated for primary anxiety problems within a randomized effectiveness trial were coded. Four coders used observational measures designed to assess technical competence, global competence, protocol adherence, and the alliance. Mean item interrater reliability was .70 (SD = .09) for technical competence and .66 (SD = .05) for global competence. While most components of global competence were distinct from technical competence scores, two components showed redundancy (r > .70). Scores on both competence measures were empirically distinct (r < .70) from scores on measures of protocol adherence and the alliance. Although the measures did not fully distinguish between technical and global competence, our findings do indicate that some components of technical and global competence may provide unique information about competence.     

Political participation and basic values in Europe: Replication and extension of Vecchione et al. (2015)

Vecchione et al. (Br J Psychol, 106 , 2015, 84) demonstrated the effects of four higher-order values on political participation across 20 European countries. In their Study 1, they found that political participation was related to three higher-order basic values and that these associations were stronger in more democratic countries. The present study attempted a replication using a more rigorous modelling approach. Multilevel structural equation models with latent variables for both participation and basic values replicated the main effects of Self-Transcendence and Conservation values but demonstrated negative effects of Openness values (vs. positive in the original study) and positive effects of Self-Enhancement values (vs. ambiguous or insignificant in the original study), while cross-level interactions indicated weaker effects of values in more democratic countries (vs. the opposite in the original study). These discrepancies appeared mostly due to the original study’s implicit assumption that basic values’ measurement errors were zero. The new results indicated a counter-intuitive similarity of effects of supposedly opposite values. Self-Transcendence–Self-Enhancement is suggested to be a politically motivating value dimension, whereas Openness to Change–Conservation is a dimension that discourages political participation regardless of the preferred extreme.     

在什么情况下员工会汇报差错?基于秘密分享视角

差错在工作场所中并不鲜见, 然而有关差错诊断的研究相对匮乏。基于此, 以员工主动差错汇报为切入点, 分析影响员工差错汇报的因素。结合秘密分享框架, 提出差错特点(差错严重性与可见性)对员工的焦虑感、反刍和汇报责任感产生正向影响; 而焦虑感、反刍和汇报责任感会促使员工采取差错汇报行为, 由此上述个体感知中介差错特点与差错汇报之间的关系; 此外, 个体责任心、领导容错性以及团队心理安全会作为边界条件进一步影响上述员工犯错后的感知, 并最终影响其差错汇报行为。     

Factors that influence the generation of autobiographical memory conjunction errors

The constructive nature of memory is generally adaptive, allowing us to efficiently store, process and learn from life events, and simulate future scenarios to prepare ourselves for what may come. However, the cost of a flexibly constructive memory system is the occasional conjunction error, whereby the components of an event are authentic, but the combination of those components is false. Using a novel recombination paradigm, it was demonstrated that details from one autobiographical memory (AM) may be incorrectly incorporated into another, forming AM conjunction errors that elude typical reality monitoring checks. The factors that contribute to the creation of these conjunction errors were examined across two experiments. Conjunction errors were more likely to occur when the corresponding details were partially rather than fully recombined, likely due to increased plausibility and ease of simulation of partially recombined scenarios. Brief periods of imagination increased conjunction error rates, in line with the imagination inflation effect. Subjective ratings suggest that this inflation is due to similarity of phenomenological experience between conjunction and authentic memories, consistent with a source monitoring perspective. Moreover, objective scoring of memory content indicates that increased perceptual detail may be particularly important for the formation of AM conjunction errors.