国外临床决策研究进展（上）

2004年～2010年国际医学决策学会年会,提出许多与临床相关的决策问题,其中包括健康经济学与成本效益分析,临床方法学研究进展,医患双方的临床决策选择,公共卫生服务研究和诊疗策略的关系,临床策略与治疗指南,高新技术与适宜技术等。本文就以上问题,尤其是临床决策研究热点,对国外临床决策研究进展进行总结、探讨和评价,为临床应...     

临床思维与决策能力是医学教育的重要组成部分

临床思维与决策能力培养是医学生不可或缺的一门必修课程,临床医生实际上每天处于临床决策之中,必须为疾病提供诊断和治疗的决策.而当前临床医学生在此方面训练甚少,临床工作具有很大的不可预知性和不可确定性,尤其是在手术室繁忙、变化的环境中,进行高效的临床决策就显得尤其重要.本文阐述了临床思维与临床决策在医学教育中的重要地位及其相互关系,分析当前医学生临床实践中的思维与决策方面存在的问题.并从临床实际角度出发,探讨如何提高医学生临床思维与决策能力的方法,对促进医学教育模式改革,提高医学教育质量具有重要推动作用.     

临床决策论坛版征文重点

临床决策论坛版近期拟以下内容为重点:1.临床决策的宏观论述。临床决策的绩效评述;临床决策与政策环境;临床决策与舆论导向;如何看待临床决策的失误;病人经济情况的临床决策;医师法与临床决策;临床组织决策。此类文章在临床决策研究栏发表。欢迎大家就临床决策中的各种问题进行     

尽快实现临床呼吸病学与相关学科的整合

阐述了对临床呼吸病学进行整合的必要性,并分别从呼吸病学与临床相关学科、呼吸病学与临床流行病学、预防医学、城市大医院与社区医疗、成人呼吸病防控与儿科呼吸病等方面进行整合的可能与方式.     

临床决策论坛版征文重点

临床决策论坛版近期拟以下内容为重点:1.临床决策的宏观论述。临床决策的绩效评述;临床决策与政策环境;临床决策与舆论导向;如何看待临床决策的失误;病人经济情况的临床决策;医师法与临床决策;临床组织决策。此类文章在临床决策研究栏发表。欢迎大家就临床决策中的各种问题进行     

影像学医师临床能力与科研水平辩证关系与对策

影像学医师的临床工作能力与科学研究水平的关系与人才培养及成才取向密切相关,对这两项任务的不同态度造就了三种不同类型的影像学医师,即重临床而轻科研、重科研而轻临床,临床与科研并重,认识两者之间的辩证关系对合格影像学人才的成长至关重要。     

临床决策论坛版征文重点

临床决策论坛版近期拟以下内容为重点: 1.临床决策的宏观论述.临床决策的绩效评述;临床决策与政策环境;临床决策与舆论导向;如何看待临床决策的失误;病人经济情况的临床决策;医师法与临床决策;临床组织决策.此类文章在临床决策研究栏发表.欢迎大家就临床决策中的各种问题进行广泛的讨论.字数不限.可从自身临床实践中的感触谈起,也可就国外此方面的情况进行介绍和评述.欢迎临床医师动笔,也欢迎业外人士发表意见.     

关于"医学检验"向"检验医学"转变的思考

"医学检验"伴随着临床化学、临床血液学、临床微生物学、临床免疫学、临床分子诊断学等学科的发展,进一步走向深化与细化.然而检验与临床之间隔阂愈演愈烈的现状,显示出还原论指导思想下的"医学检验"模式将难以适应现代医学的发展趋势,进而向着以系统论为哲学指导思想的"检验医学"模式的转变,其间正经历着一场由还原论到系统论、再实现还原论与系统论辩证统一的演化过程.     

临床决策论坛版征文重点

临床决策论坛版近期拟以下内容为重点: 1.临床决策的宏观论述.临床决策的绩效评述;临床决策与政策环境;临床决策与舆论导向;如何看待临床决策的失误;病人经济情况的临床决策;医师法与临床决策;临床组织决策.此类文章在临床决策研究栏发表.欢迎大家就临床决策中的各种问题进行广泛的讨论.字数不限.可从自身临床实践中的感触谈起,也可就国外此方面的情况进行介绍和评述.欢迎临床医师动笔,也欢迎业外人士发表意见.     

临床决策论坛版征文重点

临床决策论坛版近期拟以下内容为重点: 1.临床决策的宏观论述.临床决策的绩效评述;临床决策与政策环境;临床决策与舆论导向;如何看待临床决策的失误;病人经济情况的临床决策;医师法与临床决策;临床组织决策.此类文章在临床决策研究栏发表.欢迎大家就临床决策中的各种问题进行广泛的讨论.字数不限.可从自身临床实践中的感触谈起,也可就国外此方面的情况进行介绍和评述.欢迎临床医师动笔,也欢迎业外人士发表意见.     

催眠定义探新：以恍惚为特色的深度沟通

综述催眠发展史上主要催眠观点,归纳其激活、意境、灵活、具身及整合等基本特征,继而提出催眠是一种以恍惚为特色的深度沟通的新定义,认为催眠本质上是一种沟通,恍惚是其特色,深度与恍惚相结合有助于界定催眠。未来应加强与认知神经科学、精神分析以及中国传统文化等的融合研究。     

The Limbic System and the Soul: Evolution and the Neuroanatomy of Religious Experience

The evolutionary neurological foundations of religious experience are detailed. Human beings have been burying and preparing their dead for the Hereafter for more than 100,000 years. These behaviors and beliefs are related to activation of the amygdala, hippocampus, and temporal lobe, which are responsible for religious, spiritual, and mystical trancelike states, dreaming, astral projection, near-death and out-of-body experiences, and the hallucination of ghosts, demons, angels, and gods. Abraham, Moses, Muhammad, and Jesus Christ, and others who have communed with angels or gods display limbic system hyperactivity, whereas patients report religious hallucinations or out-of-body experiences when limbic structures are stimulated or excessively activated. It is postulated that limbic and temporal lobe structures account for the sexual and violent aspects of religious behavior and also serve as a "transmitter to God," and that the evolution of these structures made spiritual experience possible.     

Communication,Punishment, and Virtue

This essay suggests that while Antony Duff's model of criminal punishment as secular penance is pregnant with possibilities for theological reception and reflection, it proceeds by way of a number of separations that are brought into question by the penitential traditions of Christianity. The first three of these—between justice and mercy, censure and invitation, and state and victim, constrain the true communicative character of his account of punishment. The second set of oppositions, between sacrament and virtue, interior character and external action, and formal and moral reconciliation, subject the model of state punishment as secular penance to problematic liberal and libertarian constraints. A postsecular analogy, outlining a theology of the invitational nature of divine judgment, and drawing on Thomas Aquinas's account of penance as both sacrament and virtue, is proposed.     

The Arts and the Future City

The framework in which, better than in any other, cultural complexity becomes clear as a network of perspectives is the city: it is here that the greatest variety of subcultures, together with the widest range of contrasting modalities, seems able to handle its meaning. The city is at the same time an active place of cultural production and a passive and active place of memory keeping. It fuels styles and models of sensitivity also, and especially, through art and architecture. Therefore, it becomes itself a cultural model able to orient taste, but also to continually disorient it through agency. Starting from the revitalization of the cultural capital of the cities, art can play the important role of cultural magnet by catalyzing moods and emotions, conveying otherwise chaotic needs and languages, promoting new tolerance and social and cultural integration. However, in the meantime, from a secluded and distinct place that organizes the use of cultural and artistic products within recognizable boundaries, the city is becoming an undifferentiated place, a city-beyond, scattered and/or boundless. Characterized by the undifferentiated and the mutant, the uncertain and the liquid, the deformable and the relative, the space of art perception will be rethought within and without the city.     

READING HAUERWAS IN THE CORNBELT: The Demise of the American Dream and the Return of Liturgical Politics

In this paper I examine criticism of Hauerwas's critique of American democracy and liberalism, and of American violence and war, as sectarian and politically irrelevant. This twin account has the merit of engaging his critics from left and right. I show that his critique of American Christians, and their support of America's ways of promoting justice and freedom at home and in the world, has analogies with Foucault's genealogical project in France, and represents a more powerful critique of American imperialism and militarism, and of a compliant church, than efforts to sustain the purchase of rights talk or liberal justice in contemporary theological ethics.     

Science and Religion: Getting Ready for the Future

I explore three challenges for the current dialogue between science and religion: the challenges from hermeneutics, feminisms, and postmodernisms. Hermeneutics, defined as the practice and theory of interpretation and understanding, not only deals with questions of interpreting texts and data but also examines the role and use of language in religion and in science, but it should not stop there. Results of the post‐Kuhnian discussion are used to exemplify a wider range of hermeneutical issues, such as the ideological potential of scientific concepts, the dynamics of interdisciplinarity, and the significance of the socioeconomic situatedness of science and religion. Feminist research analyzes the consequences of the interplay of masculine, feminine, and gender typologies in religion and science. Examples from the history of science as well as current scientific conceptualizations indicate that beliefs in the inferiority of woman form part of our inherited scientific, religious, and metaphysical framework. It is argued that postmodernism in its most constructive form shares the best fruits of modernity, especially of the Enlightenment, while avoiding some of its most serious mistakes. In conclusion, reflecting on the three publics engaged in the dialogue between science and religion—academe, religious communities, and societies—I offer constructive suggestions and critical observations concerning the future of this dialogue.     

Dream Images

Contrasting dreams of the author, one of an old lady, another of a young girl, are brought together and explored. Swirls of feelings grow out of them, spanning many dimensions. The aliveness of dreams combines the down to earth, personal and social trauma, conflicts between survival and integrity, creativity, mystery, and a sense of the holy.     

Order,disorder, and the absolute: An experiment in dialogue

The first section of this dialogue is excerpted from an edited conversation between Sean Kelly and the late David Bohm, and focuses on the concepts of order, disorder, and the Absolute. The second section explores these concepts in greater depth, with Bohm maintaining the impossibility of absolute knowledge and the fundamental unintelligibility of the concept of disorder, preferring instead to speak of “orders of infinite degree” which emerge out of an “unknown ground.” Kelly responds by proposing the concept of “absolute knowing” as the cognitive process within which the concepts of order and disorder, the known and the Unknown are seen as dialectically related moments of the Absolute as complex whole. The third section is Edgar Morin's response to the preceding dialogue. He begins by outlining his views on the nature and limits of rationality, maintaining, with Bohm, the superiority of the “negative modality” of speaking about “being” or “reality.” In the second part, however, he proposes the notion of nature as “chaosmos,” which he understands as a creative “dialogic” of order, disorder, and organization.     

Slaves,Fetuses, and Animals

This essay is an exploration in ethical rhetoric, specifically, the ethics of comparing the status of fetuses and animals to enslaved Africans. On the view of those who make such comparisons, the fetus is treated as a slave through abortion, reproductive technologies, and stem cell research, while animals are enslaved through factory farming, experimentation, and as laborers, circus performers, and the like. I explore how the apotheosis of the fetus and the humanization of animals represent the flipside of the subjugation and animalization of black people. At their ethical best, those who compare aborted fetuses and abused animals with enslaved black people have laudable ethical goals. The anti‐abortion right and the animal rights left, respectively, wish to abolish abortion (and associated reproductive technologies that harm prenatal life) and the unethical treatment of animals. They seek, respectively, to reimagine the ethical‐political status of the fetus and to criticize the animalization of animals, the practice of constructing them as beasts. While sympathetic to these goals, I worry about the comparative diminution of the historical, literal enslavement of black people. To what extent, I ask, does the comparative ethical rhetoric of fetal slaves and animal slaves affect historical constructions of black people as beastly and disposable?     

Designing a behavioral program for a barrio in Tegucigalpa, Honduras

Health in Housing initiated a behavioral program of education and skills training for children and adults in a community of 30,000 persons living in substandard conditions in Tegucigalpa, Honduras. To measure achievement in the long-range project, 21 families of Flor del Campo participated in a preliminary three-part survey of their (a) health, (b) housing and the environment, and (c) family history. Doctors, designers, and educators worked with Honduran personnel in the first survey. Following functional analyses of the home and surrounding environment and the physical status of the individuals living there, procedures provide the family with treatment and training for home and environment improvement. Graphic, verbal, and numerical data, incorporated into a master computerized system, record events of each family member: training programs experienced, health care delivery courses taken, medical treatments, growth of children, literacy changes, educational courses completed, kinds and amounts of foods eaten, household and building materials purchased. Ongoing functional analysis and a long-range evaluation are made of the progress of each participating individual in a family. Teams revisit each house to observe and record any changes in the physical and environmental facility and the health and life-styles, and to report any indications of new health problems or recurrences.