Whither our art? Clinical wisdom and evidence-based medicine

The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute. For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other, human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why particular beliefs are held, and the epistemological status of claims based in wisdom or experience. The paper critically appraises a number of claims and distinctions, and attempts to clarify the connections between EBM, clinical experience and judgement, and the objective and evaluative categories of medicine. I conclude that to demystify clinical wisdom is not to devalue it. EBM ought not be conceived as needing to be limited or balanced by clinical wisdom, since if its language is translatable into terms comprehensible and applicable to individuals, it helps constitute clinical wisdom. Failure to appreciate this constitutive relation will help perpetuate medical paternalism and delay the adoption of properly evidence-based practice, which would be both unethical and unwise. This revised version was published online in July 2006 with corrections to the Cover Date.     

简述卫生投融资改革之目的与意义

章结合对上海卫生投融资体制和医院建设的现状分析，提出加快卫生投融资改革具有重要的目的与意义。     

Exploring the contingent reality of biomedicine: Injecting drug users,hepatitis C virus and risk1

Hepatitis C is an emerging theme of contemporary public health discourses related to illicit drug injection practices. Such discourses differentiate injecting from non-injecting users in an actuarial risk logic, targeting drug-injecting users as a population in need of support in the management of risks attributed to their practices. Public health strategies suppose, among other things, that injecting drug users adopt a homogeneous vision of hepatitis C, and of its risk, that is compatible with the reality produced by biomedicine. The majority of studies conducted on hepatitis-related risks in the context of harm reduction strategies are interested in socio-demographic factors to understand the behavioural variations within this targeted population. The meaning given to the virus and to its risk has remained marginal and the diversity of areas of construction of meaning tends to be ignored in the academic literature. Attention to this diversity indicates a complex tissue of social and communicational relations and the contingency of the symbolic instruments that people manipulate in their relation with their body and towards others; a complex tissue in which the reality of biomedicine is one among many alternative realities.     

互文性理论视野下《黄帝内经》的意义观

从《黄帝内经》的互文性、文本意义生成及其互文性对阅读的启示3方面探讨互文性理论视野下《黄帝内经》的意义观,指出《黄帝内经》作为中医经典,言简意深,现代人对其文本往往有不同理解,互文性理论是当代的一种文本理论,认为文本的互文本网络是文本意义的生产之场,故应重视文本与文本之间的关系,而且互文性理论对认识《黄帝内经》文本意义生成和文本阅读和阐释具有重要意义。     

Living With Cancer Alone? The Experiences of Singles Diagnosed With Colorectal Cancer

This paper seeks to understand the experiences of single colorectal cancer patients. This study consisted of 12 semi-structured interviews that were digitally voice-recorded, transcribed, and analyzed. Six main themes emerged: (a) gradual shift in view of cancer diagnosis from fatalistic to normalized, (b) perception of cancer as a nadir experience, (c) concerns of singlehood, (d) factors influencing cancer experiences, (e) factors influencing coping with cancer, and (f) range of responses towards cancer diagnosis. Singles with colorectal cancer require short- to long-term individualized care plans, and psycho-emotional support. This may help enhance their individual coping and adjustment to the diagnosis.     

Adaptive Defense Mechanisms: Function and Transcendence

This article reviews the high‐adaptive (mature) defense mechanisms, along with case material illustrating each. These defenses are described in terms of not only the specific means by which they serve to ward off anxiety and manage conflict, but also how they often transcend their role as defenses by contributing to the creation of new “products” of value, such as new meanings, perspectives, modes of relating, and works of art or science. This report also discusses the implications of the use of adaptive defenses, especially humor, in the context of psychotherapy.     

The influence of finding meaning and worldview of accepting death on anger among bereaved older spouses

Objectives: The purpose of the study was to identify the course and the mechanisms of the experience of anger over a 4-year period after spousal death among older adults.

Method: The study used a longitudinal prospective design with three-wave panel data (6, 18 and 48 months after spousal death), utilizing the Changing Lives of Older Couples data.

Results: Latent growth modeling analysis showed that conjugally bereaved older adults, on average, experienced a low level of anger at 6 months with a very slight decrease over a 4-year period, but individuals had a different level of anger at 6 months. Finding meaning in the death and worldview of accepting death were the significant predictors for a lower level of anger. Social support predicted a lower level of anger indirectly through finding meaning in the loss.

Conclusion: Although older adults are generally resilient to spousal loss, a substantial minority of people experience psychological distress. The relationships found suggest that it might be possible to reduce the anger of bereaved older spouses by supporting them to find meaning in the loss and by focusing bereavement support on those who have worldview of not accepting death.