对骨折治疗“优化选择”与“合理选择”的理解和思考

从合理化角度回顾了当前几种重要的骨折治疗理论体系的发展与演变,认为骨折治疗的最优原则是一种理想状态,现实中没有绝对最优只有相对合理。只有建立以患者为中心的思维体系,加强医疗逻辑思维能力,用多维思考的方式寻找矛盾的合理平衡点,始终坚守医学伦理道德底线,才能真正做到为每一位骨折患者进行最合理的治疗。     

论胰腺癌手术的术式选择

胰腺癌是一种高度恶性的腹部肿瘤.胰腺癌切除手术是一种高风险手术,如果病例选择或处理不当会造成严重后果.从哲学的高度更新指导思想和方法,对胰腺癌术式的合理选择以及提高胰腺癌治疗效果大有裨益.     

有关治疗老年股骨颈骨折最优方案的思考

老年股骨颈骨折是常见的骨科病,但其治疗方案的选择并没有统一的标准.本文回顾了骨折治疗原则的发展历程和股骨颈骨折现有的治疗方法,旨在从系统论的最优化原则角度,初步讨论治疗老年股骨颈骨折的最优方案,认为应结合患者的生理年龄、预期寿命、骨的质量、骨折情况和经济条件等因素来选择治疗方案.     

老年粗隆间骨折治疗方法的选择

股骨粗隆间骨折是老年人的常见骨折之一,患者存在骨质差、内固定稳定性差、内科合并症多,术后易发生内固定松动、断裂等诸多问题.对于老年粗隆间骨折患者Ⅰ期采用内固定还是人工关节置换手术目前存在争议.正确评估患者的骨折稳定程度,个性化选择治疗方式是保证患者早期活动,减少并发症的关键,也是治疗的金标准.     

急性ST段抬高型心肌梗死再灌注治疗的急缓之择

急性ST段抬高型心肌梗死(STEMI)最有效治疗方法是再灌注治疗,主要包括直接经皮冠状动脉介入治疗(PCI)和溶栓治疗.只有结合患者、医疗机构的实际情况,合理选择再灌注治疗方案,才能使STEMI患者获益最大化,改善其长期预后.     

胸腰段爆裂性骨折的手术策略选择

胸腰段爆裂性骨折是最常见的脊柱损伤之一,而手术治疗是其主要的治疗方式,选择最优的手术路径、做出最佳的临床抉择,是其治疗的首要目标。本文对胸腰段爆裂性骨折的不同手术入路方式及其特点做了比较和探讨,认为以最优化为原则,选择一期后路小切口有限减压的手术方式,是治疗胸腰段爆裂性骨折的最佳手术策略。     

从椎体压缩性骨折谈影像检查技术的合理选择

随着X线、计算机断层扫描、磁共振成像及正电子发射体层成像等影像检查技术的不断发展,各种影像检查方法在椎体压缩性骨折的诊断、治疗前后评价等方面被广泛应用,但各种检查技术都有各自的优势和不足,我们应根据患者实际情况为其选择合理的影像检查技术.     

重型肝炎治疗方案的理性选择

针对我国重型肝炎治疗现状,对重型肝炎常用的以及部分有争议的治疗药物和方法进行分析和讨论,就如何选择治疗方案提出医疗原则,认为应采取内科治疗-人工肝-肝移植的综合治疗模式,结合患者的治疗愿望及经济承受力,理性地选择治疗方案,以期达到合理、有效和经济的目的.     

慢性充血性心力衰竭治疗的困惑与选择

慢性充血性心力衰竭是一种严重的临床综合征 ,是大多器质性心脏病进展的最终结局。近十年来 ,心力衰竭的治疗出现了明显的变化 ,目前的治疗主要侧重于逆转衰竭心肌的生物特性 ,β受体阻滞剂就是这种治疗模式的成功典范。在短期内应用 β受体阻滞剂治疗心衰可能会加重心力衰竭 ,因此过去这类药物被长期禁用于心力衰竭患者 ,但目前的临床研究一致证实 ,合理使用 β受体阻滞剂能明显降低充血性心力衰竭患者的死亡率而延长寿命。慢性充血性心力衰竭基础和临床研究表明 ,对立和统一始终贯穿于慢性充血性心力衰竭之中。1　诊断和治疗水平的不断前…     

康复队伍建设对实现残疾人康复服务的影响

老年股骨颈骨折是常见的骨科病,但其治疗方案的选择并没有统一的标准。本文回顾了骨折治疗原则的发展历程和股骨颈骨折现有的治疗方法,旨在从系统论的最优化原则角度,初步讨论治疗老年股骨颈骨折的最优方案,认为应结合患者的生理年龄、预期寿命、骨的质量、骨折情况和经济条件等因素来选择治疗方案。     

Choice Sets and Choice Intentions

Abstract

Researchers have widely accepted the argument that the Fishbein model generally predicts better if the intention measure corresponds to the predicted behavior with respect to target, action, context, and time frame. Although the model is routinely applied in situations involving choice among multiple alternatives, researchers frequently overlook the need to measure intentions so that they correspond to the multiple target behaviors that constitute the subject'S salient choice set. The present study was designed to demonstrate the effect of choice set on the measurement of behavioral intentions of American students. The data support the argument that Fishbein'S intention measure is quite sensitive to the choice set involved, perhaps one reason why intention measures sometimes fail to predict behavior accurately.     

Choice and foraging

In Experiment 1, six naive pigeons were trained on a foraging schedule characterized by different states beginning with a search state in which completion of a fixed-interval on a white key led to a choice state. In the choice state the subject could, by appropriate responding on a fixed ratio of three, either accept or reject the schedule of reinforcement that was offered (either a variable-interval five-second or a variable-interval 20-second). If the subject accepted the schedule, it entered a “handling state” in which the appropriate variable-interval schedule was presented. Completion of the variable-interval schedule produced food. The independent variable was the fixed-interval value in the search state, and the dependent variable was the rate of acceptance of the long variable-interval in the choice state. Experiment 2 was identical except that the search state required completion of a variable-interval, instead of a fixed-interval, schedule. The rate of acceptance of the long variable-interval schedule in both experiments was a direct function of the length of the search state, in accordance with both optimality theory and the delay-reduction hypothesis.     

Choice and Culpability

Abstract

In this paper, I take exception with a widely held philosophical doctrine, according to which agents are morally responsible only for actions they have intentionally done, or chosen to bring about. I argue that that there are positive duties of consideration and proper regard that make sense of holding persons responsible in the absence of any choice to commit wrong acts.     

Choice and Logic

There is a little known paradox the solution to which is a guide to a much more thoroughgoing solution to a whole range of classic paradoxes. This is shown in this paper with respect to Berrys Paradox, Heterologicality, Russells Paradox, and the Paradox of Predication, also the Liar and the Strengthened Liar, using primarily the epsilon calculus. The solutions, however, show not only that the first-order predicate calculus derived from Frege is inadequate as a basis for a clear science, and should be replaced with Hilbert and Bernays conservative extension. Standard second-order logic, and quantified propositional logic also must be substantially modified, to incorporate, in the first place, nominalizations of predicates, and whole sentences. And further modifications must be made, so as to insist that predicates are parts of sentences rather than forms of them, and that truth is a property of propositions rather than their sentential expressions. In all, a thorough reworking of what has been called logic in recent years must be undertaken, to make it more fit for use.Portions of this paper have previously been published in Logical Studies, vol. 9, http://www.logic.ru/LogStud/09/No9-06.html, and the Australasian Journal of Logic, vol. 2, http://www.philosophy.unimelb.edu.au/ajl/2004/2004_4.pdf.     

识解水平对跨期选择和风险选择的影响

通过考察识解水平启动对跨期选择和风险选择的影响, 探究两类选择对时间或风险心理加工的相似性。结果发现, 无论以思维诱导为识解水平的启动条件(实验1), 还是以视觉加工为识解水平的启动条件(实验2), 受高识解水平启动的被试对延迟选项和风险选项的主观值判断都要大于受低识解水平启动的被试, 说明跨期选择中的延迟时间和风险选择中的概率具有相似的表征, 而识解水平思维定势是通过影响金额和时间(或概率)的相对权重起作用。即由于高识解水平下的金额权重高于低识解水平, 时间(或概率)权重低于低识解水平, 从而使被试在高识解水平下更愿意等待或冒险。     

心理距离对跨期选择和风险选择的影响

通过考察时间距离、社会距离和概率距离对跨期选择和风险选择的影响, 探究跨期选择和风险选择心理过程的相似性, 并检验不同心理距离影响决策的相似性。结果发现, 无论是时间距离(实验1)、社会距离(实验2)、还是概率距离(实验3), 心理距离越远, 被试在跨期选择中越倾向于延迟选项, 在风险选择中越倾向于风险选项。研究认为, 在跨期选择和风险选择中, 选项的表征结构和选项整体评价时不同选项特征的相对权重具有相似性。随着心理距离增加, 与高识解相联系的金额特征的相对权重增加, 与低识解相联系的时间和概率特征的相对权重降低, 这使得被试更倾向于选择金额较大的延迟和风险选项。同时, 研究发现三类心理距离对两类决策有相似影响, 进一步验证了不同心理距离的本质相似性。     

Choice

Understanding how and why analysands make the choices they do is central to both the clinical and the theoretical projects of psychoanalysis. And yet we know very little about the process of choice or about the relationship between choices and motives. A striking parallel is to be found between the ways choice is narrated in ancient Greek texts and the experience of analysts as they observe patients making choices in everyday clinical work. Pursuing this convergence of classical and contemporary sensibilities will illuminate crucial elements of the various meanings of choice, and of the way that these meanings change over the course of psychoanalytic treatment.