从哲学眼界论医学、健康安全与卫生经济

从哲学眼界看,医学与健康都是多元的概念,是许多相互交叉、渗透、影响、制约的因素互相作用的结果.医学、健康保健应适应经济水平,即我们应向患者及社会提供一个安全的、科学的、用的起的、可持续的医疗与健康保健服务.较多贪婪的、不安全的医学时代,最好的计划是不断进行几元钱的预防医学投入和适当的姑息医学.     

关于医学整合的几点认识

医学整合对医学发展整体趋势的回应;医学专业学科的整合,临床与预防、公共卫生的整合,保健服务与全民健康促进的整合,医学教育与保健服务的整合,医学人文与医学的整合,是当前是最为迫切的整合;构建新的保健服务体系,实现保健服务的公平,是医学整合的核心;医学整合是创新,也是革命。     

关于医学整合的几点认识

医学整合对医学发展整体趋势的回应;医学专业学科的整合,临床与预防、公共卫生的整合,保健服务与全民健康促进的整合,医学教育与保健服务的整合,医学人文与医学的整合,是当前是最为迫切的整合;构建新的保健服务体系,实现保健服务的公平,是医学整合的核心;医学整合是创新,也是革命.     

医学目的与发展自我保健医学的意义

随着社会进步和医学的发展,应将医学的全域性发展与医学伦理模型和医学目的的全新转变有机地结合起来,即建立“公正、均衡的医学伦理模型”。其含义是强调生命质量价值;维护人人平等的健康权;实现各方面与医学和健康有关的权力与义务的统一。关键在于创建和发展自我保健医学。它是以现代科学理论为基础,研究人类生命活动、保健需求、自我保健行为及社会活动规律;并通过“自我保健医学”诊断和开具自我保健处方,实施健康促进工     

中国人口健康转型与医学整合

当前中国处于人口健康转型阶段,慢性病主要危险因素处于失控状况,潜在危险日益严重,疾病的直接、间接负担呈明显的加速趋势,健康形式不容乐观。推进医疗、预防、保健的整合,从保健政策上支持医学整合,是控制危险因素,遏止、扭转和减少慢性病的蔓延非常关键性的措施。     

论健康需求的无限性和医学责任的有限性

健康需求是人类的基本需求,人类对健康这一理想生存状态的需求是无限的;而在保健和促进健康的过程中,医学的责任则是有限的,这主要是由医学自身的特点和能力所决定,对于医疗责任的模糊认识是“医学万能论”和“医学异化现象”产生的思想根源,也是医患关系紧张的重要原因,因此,正确认识医学对健康责任的有限性对于正确评价医学的作用。准确把握医学发展方向,更好地满足人类的健康需求,有着重要的现实意义。     

卫生保健政策与医学伦理学

卫生保健政策是卫生资源、价值目标和伦理原则三者的结合。医学伦理学是卫生政策的重要基础。当代卫生事业的特点,卫生保健服务面临的挑战以及医学伦理主体与客体的变化,决定了医学伦理学在当代卫生保健政策中的特殊意义。在医学面临全民保健的阶段,一个科学的符合人民健康利益的卫生保健政策是不言而喻的。摆脱当前卫生政策面临的困难,要求必须在医学伦理学方面作出正确的选择。     

对医学人文社会科学综合课程改革的初步评价

1　研究与评价的背景加强医学生的人文素质教育已成为医学教育改革的重要内容。为此,我们一方面认真探索和稳步推进医学院校人文社科类课程体系的改革;另一方面又积极开展了建立医学与人文社会科学综合课程的尝试,以便在有限的课时内加强医学生的人文素质教育。这一改革的思路是:根据需要与可能,结合专业特点,以健康、保健为中心,把与医学相关的人文社会科学的理论与方法整合为一门课程,在临床医学、护理、口腔医学等专业研究生和本科生中试点开设。其主要内容有:健康与社会文化;社会进步与医学模式转变;卫生保健的社会公平性;医疗保险体制…     

新世纪医疗卫生服务值得思考的几个问题

随着新世纪的到来,社会经济的发展,人口谱、疾病谱的变化,医学科学技术的进步,向医疗卫生保健事业提出了挑战。人人享有卫生保健与全民医疗保险、预防医学的振兴与医疗卫生服务体系改革与完善是医疗卫生保健服务值得思考的问题。     

论发展我国社区医学服务

本文提出发展社区医学服务是医疗卫生服务模式的一次变革。认为发展社区医学服务是适应人类疾病谱和死亡谱的变化,是适应人口老龄化发展趋势和医学模式改变的需要。作者提出社区医学服务的概念的目的是强调这种新的服务模式是集医疗,预防,保健,康复,健康教育,咨询和卫生服务为一体的全方位的全程服务模式。     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

循证医学与临床实践

循证医学是９０ 年代诞生的新兴医学科学。其要点是将临床医学领域的研究结果进行系统、全面的综合评价,为临床医疗实践、科研、卫生决策和医学教育提供可靠的科学证据。在发达国家的运用表明它已经对临床实践产生了重大而深远的影响,并将继续在临床医学领域发挥重要的作用。     

循证医学的辩证思维

随着临床医学的发展,临床医生面临着从理论知识加个人经验的医学模式向以科学证据为基础的医学模式转变。越来越多的卫生政策和诊疗指南的制定需要以高质量的研究结果为依据,如随机对照研究的结果,特别是随机对照研究的系统综述结论。循证医学模式要求医生在临床工作中不断提出问题并通过严格的科研设计来回答这些问题,同时强调不断进行知识更新,掌握最新研究证据以指导其临床工作。同时政府部门也鼓励发展循证医疗,因为它可通过研究有效的诊疗手段来提高卫生保健的效率。此外还有迹象表明法律决策过程中要参考是否遵循了研究证据和临床指南。知情的服务对象也促使临床工作者寻求研究证据作为依据,为了提高服务质量并且充分把握特殊专业领域的现状,临床工作者也需要不断了解新的依据信息。在众多的研究信息中,我们应对每项证据的研究方法、研究对象及观察的终点进行认真分析,确定该结论是否真实并适合我们的实际,从而制定有据可查的诊疗方案。     

Intelligence artificielle et médecine : quelles règles éthiques et juridiques pour une IA responsable ?

Combining AI and medicine means talking about the medicine of the future, but even more about improving the quality of care. Its fields of application: predictive medicine, precision medicine, decision support, prevention, computer-assisted surgery, robotic support for the elderly, etc. are all related concerns: the possibility of maintaining human contact with the patient, the explicability of the algorithm - the collection of health data - and the improvement of the health care system. AI applications are already improving the quality of care. Its deployment at the heart of the medicine of the future is in constant evolution. To be acceptable and legitimate, the decisions of any algorithm must be understood and therefore explained. Only a good understanding of the diagnoses and therapies proposed by the AI application will allow doctors to discuss with their patients and to explain the possible alternatives. In the opposite case, the doctor risks to dismiss the use of algorithms because he will not be able to justify the decisions which will pose problems in terms of liability research in particular.     

Ethical implications in the allocation of scarce medical resources in Poland

The health care system in Poland is undergoing major change and it is possible that these changes could affect clinical research. Therefore, the situation of funding of health care is important for the future of medical research in this country. Some questions relevant in this field will be addressed. Since funds for health care and scientific research remain inadequate, their allocation raises moral, economic, legal and organisational dilemmas. The clinical aspects of resource allocation also include physicians’ responsibilities towards their patients. Scientific research, clinical medicine, and clinical research have a common denominator: they rely on trust. The physician should be a fiduciary of the patient as well as being a researcher for the benefit of the patient and for society. Some physicians and researchers, despite unethical conduct, escape disclosure and punishment, but decision-makers who wrongly allocate funds for health care and research are never held accountable for their actions. An earlier version of this paper was presented at a symposium, Scientific Misconduct: An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998.     

The Difficulty of Making Psychology Research and Clinical Practice Relevant to Medicine: Experiences and Observations

Psychology and medicine research and practice have demonstrated substantial and unique bodies of knowledge designed to both improve patient care and respond to contemporary health care needs for use of evidence and cost consciousness. At their full potential they represent a significant paradigm shift in healthcare. Despite impressive successes, it is clear that we are just on the cusp of such a change. These findings have had limited impact and penetration into medical practice, particularly outside of academic medicine and large, organized systems of health care, and there are multiple examples of such limitations in various arenas of health care. There also appear to be common themes to such examples which provide us opportunities to consider how psychologists might move things ahead. They also suggest how our unique position in academic medicine can both limit our impact and provide ways of creating continued shifts in the healthcare paradigm. This paper is based in part on the author’s presentation at the Association of Psychologists in Academic Health Centers 3rd National Conference in Minneapolis, Minnesota, May 2007.     

The Problem of Integrating Behavioral Health in the Medical Home and the Questions It Leads to

Psychology and other behavioral health professions have amassed a broad empirical and clinical literature suggesting many medical presentations are best responded to with the addition of evidence based behavioral interventions. Despite this, psychology has not achieved a regular presence as part of medical practice. We suggest specific reasons for the current state of affairs including clinical, operational, societal labels, financial and training dimensions. Medical, psychological, administrative, and financial perspectives are reviewed. If the goals of health care system reform are to be reached then we must identify and challenge the current limitations of health care. This paper will identify the elements that need to be changed in order for psychology to be integrated into medicine rather than excluded from its policy, planning and operations.     

略论“协和模式”的形成及其社会影响

北京协和医学院在中国现代医学史上占有重要的历史地位,对于我国医学教育和医疗卫生事业发展起到了不可忽视的推动作用。它在办学实践过程中形成了一套颇具特色的医学教育模式,培养出大批杰出的科研专家、学者和医疗工作者,为中国现代医学发展和医疗卫生制度建设做出了杰出贡献,积累了宝贵经验。     

"以病人为中心"医疗服务模式的理念与发展

纵观20世纪医疗服务的发展历程,医疗服务的发展经历了“以疾病为中心”的传统医疗服务模式到“以病人为中心”的新的医疗服务模式的转变;目前,以“以病人为中心”的医疗服务模式已经成为我国现代医院改革与发展的主题。因此,在阐述医疗服务模式变革与发展的基础上,系统论述了“以病人为中心”的医疗服务模式的内涵与特点,新的理念、新的认识,也带来了新的希望,新的医疗服务模式将不断地改善与提高人们的健康状况与生活质量。     

姑息医学在大肠癌治疗中的地位和应用策略

大肠癌的治疗应采用一种无缝的连接方式将姑息治疗与抗肿瘤治疗整合在一起。姑息医学的采用应贯穿肿瘤治疗的始终,以期更好地提高生命质量,尊重生命价值,体现医学本质和人文关怀。