咨询师自我表露的定性研究

目的:探索咨询师有关自我表露的认识、态度,以及自我表露的决策过程.方法:对18位咨询师进行半结构化的访谈,然后以协商一致的定性研究(CQR)方法对访谈文本进行分析处理.结果:咨询师自我表露涉及认识、态度、内容、情境、动机、考虑因素和变化7个主题.咨询师普遍认为自我表露有积极作用,对自我表露持接受、认可的态度.咨询师在4种典型情境中较容易自我表露:当事人有不合理的观念或想法;咨询不顺利,难以进行下去时;咨询师有类似的经历;当事人主动要求.在进行决策时,咨询师会考虑是否要表露、何时表露及如何表露三方面的问题.结论:咨询师的自我表露具有积极作用,咨询师自我表露会经历一个复杂的决策过程.     

Reflective research: Supporting researchers engaged in analyzing end-of-life communication

Objectives

The objectives of this commentary are to: (1) identify unique aspects of communication at end-of-life as compared to more commonly studied healthcare encounters; (2) outline challenges and opportunities research team members may encounter in coding and analyzing end-of-life communication; and (3) offer recommendations for quantitative communication research teams.This commentary is based on ours and others’ experiences in studying the communication among patients with terminal illnesses, their families and their providers.Provider-patient/caregiver communication at end-of-life has some differences as compared to other forms of healthcare communication and, thus, has implications for researcher response. Challenges and opportunities for research team members include gaining new knowledge, developing feelings of attachment to study participants, burn-out, and emotional and existential impact on personal life. Practical and psychological considerations for conducting end-of-life communication research are discussed.

Conclusions

Researchers engaged in the study of end-of-life interactions may experience unique challenges, potentially compromising the validity of the research results and interpretation of communication processes. A balance between likely coder emotions and objectivity must be achieved.

Implications

Anticipating and facilitating the research teams’ reactions to end-of-life interactions while still maintaining scientific standards may be achieved by using a reflective, mindful approach.     

Ethical principles and the rationing of health care: a qualitative study in general practice

BACKGROUND: Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. AIM: To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources. DESIGN OF STUDY: A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. SETTING: Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. METHOD: Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. RESULTS: With respect to the ethical basis for decision making, the findings from this part of the study emphasised the role of social and psychological factors, the influence of the quality of the relationship between GPs and patients and confusion among GPs about their role in decision making. CONCLUSION: The use of vignettes developed from prior interviews with GPs creates a non-threatening environment to discuss sensitive or controversial issues. The acceptance by GPs of general moral principles does not entail clarity of coherence of the application of these principles in practice.     

Employing a systematic approach to biobanking and analyzing clinical and genetic data for advancing COVID-19 research

Within the GEN-COVID Multicenter Study, biospecimens from more than 1000 SARS-CoV-2 positive individuals have thus far been collected in the GEN-COVID Biobank (GCB). Sample types include whole blood, plasma, serum, leukocytes, and DNA. The GCB links samples to detailed clinical data available in the GEN-COVID Patient Registry (GCPR). It includes hospitalized patients (74.25%), broken down into intubated, treated by CPAP-biPAP, treated with O₂ supplementation, and without respiratory support (9.5%, 18.4%, 31.55% and 14.8, respectively); and non-hospitalized subjects (25.75%), either pauci- or asymptomatic. More than 150 clinical patient-level data fields have been collected and binarized for further statistics according to the organs/systems primarily affected by COVID-19: heart, liver, pancreas, kidney, chemosensors, innate or adaptive immunity, and clotting system. Hierarchical clustering analysis identified five main clinical categories: (1) severe multisystemic failure with either thromboembolic or pancreatic variant; (2) cytokine storm type, either severe with liver involvement or moderate; (3) moderate heart type, either with or without liver damage; (4) moderate multisystemic involvement, either with or without liver damage; (5) mild, either with or without hyposmia. GCB and GCPR are further linked to the GCGDR, which includes data from whole-exome sequencing and high-density SNP genotyping. The data are available for sharing through the Network for Italian Genomes, found within the COVID-19 dedicated section. The study objective is to systematize this comprehensive data collection and begin identifying multi-organ involvement in COVID-19, defining genetic parameters for infection susceptibility within the population, and mapping genetically COVID-19 severity and clinical complexity among patients.Subject terms: Genetics research, Viral infection     

心理咨询师胜任特征的定性研究

目的:构建心理咨询师胜任特征模型。方法:对20名心理咨询师进行行为事件访谈,以国家首批注册心理督导师为效标,将访谈对象分为绩优组和一般组,每组各10名。编写《心理咨询师胜任特征研究编码手册》,根据编码手册中的23个胜任特征条目及其等级评分标准,对访谈资料进行编码分析。使用Mann-Whitney U检验,考察在绩优组和一般组之间存在差异的条目,初步得到心理咨询师鉴别性胜任特征;考察出现频次较高的条目,初步得到心理咨询师基准性胜任特征。采用内容评价小组方法,通过计算各条目的内容效度比率(content validity ratio,CVR),对初步得到的胜任特征进行内容效度检验。结果:两组心理咨询师在建立关系的基本态度、人际理解和洞察、弹性、影响力、自我觉察、自我控制力、人格健全与完善、阅历与经验、专业知识与技能9个条目上差异有统计学意义(P0.05),并通过内容效度检验(CVR0.33),将其定义为鉴别性胜任特征。编码结果中出现频次较高,且通过内容效度检验(CVR0.33)的11个条目为利他性、建立关系的基本态度、人际理解和洞察、尊重、培养他人、自我觉察、自我控制力、开放性、语言表达能力、人格健全与完善、专业知识和技能,定义为基准性胜任特征。结论:心理咨询师胜任特征模型包括基准性胜任特征和鉴别性胜任特征两个部分。     

Role of similarity principles in data extrapolation

This paper addresses the problem of extrapolating from data set gathered on a particular system to problems of more general physiological interest. It asks: what are the limits of the extrapolability of data? Under what circumstances can data derived from a particular system be transformed into data about another, different system? Such questions address the general problem of similarity analysis. A mathematical exploration of the meaning and usefulness of the concept of similarity is presented, and the necessity for a "prototype" is introduced. The discussion shows what we mean by the relationship between natural systems and the purest form of model of such systems, the mathematical model. The value and limitations of Dimensional Analysis are considered. It is concluded that the principle of dimensional homogeneity which underlies Dimensional Analysis is not strong enough to cope effectively with situations involving many phases, as arise in biological studies. Therefore, a more general approach is used. It is shown that the problems associated with data extrapolation are very deep and lead to some of the deepest issues in all of science. The extrapolation of data from animal models to human beings has been a general characteristic of pharmacologic research and, for that matter, biomedical investigations generally. Attention to limitations and dangers of such extrapolations seems overdue. With proper understanding of the essential nature of the extrapolatory action, and modeling relations, models can be validated.     

Sexual contact between clinical psychologists and their patients: qualitative data

This paper is the second in a series of two articles which describe the results of a national survey of 581 clinical psychologists relating to sexual issues in therapy. This paper describes the responses to open‐ended questions relating to the reasons given by respondents for not experiencing sexual attraction towards patients, for avoiding sexual contact with patients, and for not taking action to prevent the continuation of sexual contact between clinical psychologists and their patients. A system of categories was developed which described the responses given to each of these questions. The reliability of the taxonomy was considered and was found, overall, to be an appropriate method of organizing the data. Where previous research has addressed similar questions, the present study achieved similar categories of data. Respondents most frequently cited professional and personal values and ethics, boundary issues and the impact upon the patient, as reasons for avoiding sexual contact with patients. However, some respondents (approximately 22%) suggested that they avoided such contact because of the consequences of detection or lack of opportunity. The majority of respondents who had not experienced sexual attraction towards patients cited as their reasons for this, the nature of the patient group. However, a substantial proportion responded in such a way as to suggest that they considered sexual attraction towards their patients to be inappropriate. The main reason given for not reporting a colleague known to have had sexual involvement with patients was that action in some form had already been taken, but some psychologists seemed unaware of their duty to report such colleagues. The training and professional implications of the results of the survey are discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

Finding disease genes: a fast and flexible approach for analyzing high-throughput data

Linkage disequilibrium (LD) is the non-random distribution of alleles across the genome, and it can create serious problems for modern linkage studies. In particular, computational feasibility is often obtained at the expense of power, precision, and/or accuracy. In our new approach, we combine linkage results over multiple marker subsets to provide fast, efficient, and robust analyses, without compromising power, precision, or accuracy. Allele frequencies and LD in the densely spaced markers are used to construct subsamples that are highly informative for linkage. We have tested our approach extensively, and implemented it in the software package EAGLET (Efficient Analysis of Genetic Linkage: Estimation and Testing). Relative to several commonly used methods we show that EAGLET has increased power to detect disease genes across a range of trait models, LD patterns, and family structures using both simulated and real data. In particular, when the underlying LD pattern is derived from real data, we find that EAGLET outperforms several commonly used linkage methods. In-depth analysis of family data, simulated with linkage and under the real-data derived LD pattern, showed that EAGLET had 78.1% power to detect a dominant disease with incomplete penetrance, whereas the method that uses one marker per cM had 69.7% power, and the cluster-based approach implemented in MERLIN had 76.7% power. In this same setting, EAGLET was three times faster than MERLIN, and it narrowed the MERLIN-based confidence interval for trait location by 29%. Overall, EAGLET gives researchers a fast, accurate, and powerful new tool for analyzing high-throughput linkage data, and large extended families are easily accommodated.     

网络心理咨询伦理问题的定性研究

目的:探索即时文字网络心理咨询特有的伦理问题,为制定网络心理咨询伦理规范提供依据。方法:选取自愿参加研究的10名网络心理咨询师所做的10个即时文字网络咨询案例,研究者参加网络咨询师的小组督导讨论8次,每次2～4 h,综合考虑督导讨论中重复出现和反复阅读咨询文本两种途径,最后由3位研究者共同讨论确定伦理议题,并从咨询文本中选取典型性对话进行分析。结果:与网络心理咨询相关的伦理议题包括4方面。①在网络咨询中咨询师以真实身份与来访者建立关系,来访者须提供必要的真实信息;②咨访双方注意选择网络咨询的地点、时间并避免多任务操作以保证咨询设置;③网络咨询对网络平台及咨询记录有特殊的保密要求;④危机个案应有专门的应急方案并及时转为线下干预。结论:网络心理咨询伦理规范在咨询关系、咨询设置、保密性以及危机干预方面有独特性。     

Use of a television analyzing system in microcirculatory research

To investigate quantitative structural and functional characteristics of the microcirculationin vivo a Leitz television analyzing system was used. In experiments on anesthetized rats the degree of development of the microcirculatory network and the geometric characteristics of the microvessels themselves were determined, changes in the blood volume were estimated, and the degree and spread of disturbances of vascular wall permeability were examined.Laboratory of General Physiology and Experimental Therapy, Institute of General Pathology and Pathological Physiology, Academy of Medical Sciences of the USSR, Moscow. Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 87, No. 5, pp. 497–500, May, 1979.     

Bayesian inference from qualitative and quantitative data in program evaluation

Current practice in program evaluation relies strongly on quantitative measurement and classical (sampling-theory) statistical inference, methods that invariably fail to use all of the relevant information available to the evaluator. The use of Bayesian methods to combine inferences from quantitative and nonquantitative data is described and illustrated. The reporting of results based on multiple distributions that express contrasting assessments of prior information is recommended in order to acknowledge and control for differences in subjective points of view. Advantages of using Bayesian inference in program evaluation include the possibility of generating inferences when little or no quantitative data are available, its applicability to evaluation at all stages of program development, and its requirement that evaluators be explicit regarding the influence of qualitative information and alternative points of view in the evaluation of social programs.     

Setting priorities in global child health research investments: assessment of principles and practice

This article reviews theoretical and practical approaches for setting priorities in global child health research investments. It also provides an overview of previous attempts to develop appropriate tools and methodologies to define priorities in health research investments. A brief review of the most important theoretical concepts that should govern priority setting processes is undertaken, showing how different perspectives, such as medical, economical, legal, ethical, social, political, rational, philosophical, stakeholder driven, and others will necessarily conflict each other in determining priorities. We specially address present research agenda in global child health today and how it relates to United Nation's (UN) Millennium Development Goal 4, which is to reduce child mortality by two-thirds between 1990 and 2015. The outcomes of these former approaches are evaluated and their benefits and shortcomings presented. The case for a new methodology for setting priorities in health research investments is presented, as proposed by Child Health and Nutrition Research Initiative, and a need for its implementation in global child health is outlined. A transdisciplinary approach is needed to address all the perspectives from which investments into health research can be seen as priorities. This prioritization requires a process that is transparent, systematic, and that would take into account many perspectives and build on advantages of previous approaches.     

Public responses to the sharing and linkage of health data for research purposes: a systematic review and thematic synthesis of qualitative studies

Background

The past 10 years have witnessed a significant growth in sharing of health data for secondary uses. Alongside this there has been growing interest in the public acceptability of data sharing and data linkage practices. Public acceptance is recognised as crucial for ensuring the legitimacy of current practices and systems of governance. Given the growing international interest in this area this systematic review and thematic synthesis represents a timely review of current evidence. It highlights the key factors influencing public responses as well as important areas for further research.

Methods

This paper reports a systematic review and thematic synthesis of qualitative studies examining public attitudes towards the sharing or linkage of health data for research purposes. Twenty-five studies were included in the review. The included studies were conducted primarily in the UK and North America, with one study set in Japan, another in Sweden and one in multiple countries. The included studies were conducted between 1999 and 2013 (eight studies selected for inclusion did not report data collection dates). The qualitative methods represented in the studies included focus groups, interviews, deliberative events, dialogue workshops and asynchronous online interviews.

Results

Key themes identified across the corpus of studies related to the conditions necessary for public support/acceptability, areas of public concern and implications for future research. The results identify a growing body of evidence pointing towards widespread general—though conditional—support for data linkage and data sharing for research purposes. Whilst a variety of concerns were raised (e.g. relating to confidentiality, individuals’ control over their data, uses and abuses of data and potential harms arising) in cases where participants perceived there to be actual or potential public benefits from research and had trust in the individuals or organisations conducting and/or overseeing data linkage/sharing, they were generally supportive. The studies also find current low levels of awareness about existing practices and uses of data.

Conclusions

Whilst the results indicate widespread (conditional) public support for data sharing and linkage for research purposes, a range of concerns exist. In order to ensure public support for future research uses of data greater awareness raising combined with opportunities for public engagement and deliberation are needed. This will be essential for ensuring the legitimacy of future health informatics research and avoiding further public controversy.

     

Problems and paradigms in ERP research

The ERP technique may provide noninvasive measures that are associated with the processing of psychological information during the performance of a task. Some investigators even regard ERPs as direct manifestations of the psychological processes induced by the demands of the task. Before such a strong claim can be made several methodological problems must be resolved. The present paper discusses the definition and identification of the endogenous components in the ERP, the separation of endogenous components from exogenous components, and the different ways in which inferences can be made about psychological processes on the basis of ERP measures.