白内障手术中的适宜技术与诊疗最优化

在临床工作中为避免过度医疗,普遍的原则是大力推行适宜技术、适度医疗,并努力实现诊疗的最优化。在我国现阶段,适宜技术是一个宽泛且较低的标准,白内障手术中的适宜技术并不能使患者获得最佳疗效,达不到最优化医疗的要求。相信随着我国医疗体制的健全,白内障患者可以享受到最优化医疗。     

口腔专业适宜技术与诊疗最优化

推行适宜技术和诊疗最优化的原则是避免过度医疗的有效途径.而在口腔专业中必须要体现其特殊性.口腔治疗的总体目标是健康、美观,这一目标有赖于患者的主观评价;患者在治疗中具有自主选择的权利,而医生提供专业上的支持和具体的执行.因此口腔科适宜技术的基本要求是:适合患者的自身条件和需求、符合医学专业诊疗原则的要求以及适合医生的个人技术水平.然而对于我国现阶段而言,适宜技术是一个宽泛且较低的标准,而口腔临床工作中应该以最优化的治疗作为实际追求的目标.     

口腔专业适宜技术与诊疗最优化

推行适宜技术和诊疗最优化的原则是避免过度医疗的有效途径。而在口腔专业中必须要体现其特殊性。口腔治疗的总体目标是健康、美观,这一目标有赖于患者的主观评价;患者在治疗中具有自主选择的权利,而医生提供专业上的支持和具体的执行。因此口腔科适宜技术的基本要求是:适合患者的自身条件和需求、符合医学专业诊疗原则的要求以及适合医生的个人技术水平。然而对于我国现阶段而言,适宜技术是一个宽泛且较低的标准,而口腔临床工作中应该以最优化的治疗作为实际追求的目标。     

适宜技术与诊疗最优化临床应用患者方面的影响因素

从诊疗中的认识论和辩证法的角度,通过实际案例分析医生及患者对选择适宜技术实现诊疗最优化的消极和积极的影响;阐述了患者自身的经济状况在很大程度上影响着适宜技术的应用;患者的心理因素和家人的态度在一定程度上也影响着适宜技术的应用及实现诊疗最优化.医生要提高自己的综合素质,患者要充分发挥自己的主观能动性,消除消极的影响,增强积极的影响,共同促进适宜技术的临床应用及实现诊疗最优化.     

白内障手术治疗的发展与思考

白内障是常见的致盲眼病之一,目前治疗白内障唯一有效的方法是通过手术摘除混浊的晶状体并植入人工晶状体.随着白内障摘除手术技术的提高和仪器设备的不断更新,手术理念已由原来的白内障复明手术逐渐向白内障屈光手术转变,手术目的已不单纯局限在复明,而是旨在恢复更合乎生理状况的视觉功能.随着科学技术的发展,白内障手术技术的日趋成熟,人们关注的重点也逐渐从手术效果、术后视力的恢复,过渡到手术过程中患者的舒适程度、满意程度上来.使得白内障的手术治疗过程更具有人性化的特点,体现了当代医疗对患者的人文关怀.     

适宜技术与诊疗最优化临床应用患者方面的影响因素

从诊疗中的认识论和辩证法的角度,通过实际案例分析医生及患者对选择适宜技术实现诊疗最优化的消极和积极的影响;阐述了患者自身的经济状况在很大程度上影响着适宜技术的应用;患者的心理因素和家人的态度在一定程度上也影响着适宜技术的应用及实现诊疗最优化。医生要提高自己的综合素质,患者要充分发挥自己的主观能动性,消除消极的影响,增强积极的影响,共同促进适宜技术的临床应用及实现诊疗最优化。     

适宜技术与过度医疗的管理

从医疗管理的角度来说,过度医疗和适宜技术不是一成不变的绝对矛盾,是可以相互转换的.针对不同经济能力、教育背景、社会心理需求的患者,适宜技术和过度医疗应该有不同的标准.比如,用一次性肠管吻合器进行肠管吻合,器械费用2 000多元,这个对富人来说就是适宜技术,不是过度医疗;但对经济条件不好的农民来说,就是过度医疗,对他们来说用手工缝合术才是适宜技术.因此,并非任何优质医疗都要以高技术为条件.两者不能划等号.高技术是优质医疗的重要条件,但不是必要条件[1].     

糖尿病患者白内障术后并发症的分析及处理

白内障超声乳化手术使得广大糖尿病患者术后获得了良好视力,但作为一个特殊高危群体,手术后并发症不容忽视.本文结合以往我科临床经验,按照发生率的高低,就糖尿病患者白内障术后并发症的发生情况作一剖析,并参照相关文献,讨论分析其发生的危险因素,及在临床工作中如何预防或减低糖尿病患者白内障术后并发症的发生几率,以期警示临床进一步加强围手术期管理制度,针对患者具体情况,依据临床专业理论和经验,作出最优化临床决策.     

过度医疗、适度医疗与诊疗最优化

过度医疗与过度服务有所不同.适度医疗应当是为患有某种疾病的病人提供有效、安全、便捷、耗费少的医疗服务.最优化的医疗是一种包括以优质的医疗服务实现了最佳疗效、最安全、痛苦最少、最便捷和费用低的医疗.一般地说,最优化的医疗首先应当是适度的医疗.最优化的医疗比适度医疗有更高的要求.不宜用优质医疗取代适度医疗,也不宜将适度医疗改称为最优化医疗.我们可以将适度医疗作为保健服务的基本要求,而将最优化医疗作为努力目标,一种理想化的目标.在满足人民的基本医疗、实行基本医疗保险过程中,我们更应当提倡适度医疗.     

自内障手术治疗的发展与思考

白内障是常见的致盲眼病之一,目前治疗白内障唯一有效的方法是通过手术摘除混浊的晶状体并植入人工晶状体。随着白内障摘除手术技术的提高和仪器设备的不断更新,手术理念已由原来的白内障复明手术逐渐向白内障屈光手术转变,手术目的已不单纯局限在复明,而是旨在恢复更合乎生理状况的视觉功能。随着科学技术的发展,白内障手术技术的日趋成熟,人们关注的重点也逐渐从手术效果、术后视力的恢复,过渡到手术过程中患者的舒适程度、满意程度上来。使得白内障的手术治疗过程更具有人性化的特点,体现了当代医疗对患者的人文关怀。     

Seeing and hearing and space and space and time

A previous experiment had shown spatial location to be judged in terms of the framework provided by the modality in which stimuli were presented. In the present study, digits were either auditorally or visually presented, and in either form the three digits appeared successivly to the left, in the center, and to the right of the S. The digit which occurred temporally in the middle of the sequence was never central from the spatial viewpoint. The S was asked to indicate which digit was the middle one. Ss were blind, deaf, or normal. The deaf and two control groups saw visual displays, and the blind and their controls heard auditory displays. The former groups predominantly chose the spatially middle digit and the latter groups the temporally middle. It was concluded that modality of presentation was the trigger which switched in the coding dimension of time or space.     

Bob and Carol and Tess and Ali

Conflicting religious experiences in different traditions do not necessarily defeat the rationality of conflicting beliefs sustained by those experiences in those traditions. The circularity that protects religious beliefs from such mutual defeat is not vicious. Moreover, the lack of ‘epistemological humility’ exhibited by such believers poses no threat to world peace. In fact, a campaign for compulsory humility would itself constitute a much greater threat.     

Law and Gospel,and Youth and Family Ministry

Abstract : If “faith comes through hearing” the word of God comprised in law and gospel, how do the imperatives that characterize ‘Youth and Family Ministry’ make such hearing possible? Here, literature delineating ‘Youth and Family Ministry’ is analyzed in light of its biblical foundations. The primary lens implemented in this analysis is the law/gospel hermeneutic advocated by Martin Luther and other reformers.     

Extremes of self-esteem and narcissism and the experience and expression of anger and aggression

This study examined the level of self-esteem and narcissism as personality variables involved in the disposition to experience and express anger. Three hundred thirty-eight subjects were sampled across two higher education centres and one student teaching programme in the United Kingdom. It was reasoned that individuals with both high self-esteem and narcissism would report especially high tendencies to experience and express anger and aggression and that those with high self-esteem and low narcissism would report the lowest. These predictions were influenced by theories that emphasise the role of threats to high self-esteem in the production of aggression and violence. Results indicate that groups defined by their extreme scores on self-esteem and narcissism scales produced levels of anger expression in the predicted direction. The importance of considering extreme levels of self-esteem and narcissism (in conjunction with other factors) in an analysis of anger is discussed with reference to currently influential theories in the field. Aggr. Behav. 24:421–438, 1998. © 1998 Wiley-Liss, Inc.     

Dance and psychotherapy--possibilities and limits

From a starting point of therapeutic and prophylactic components identifiable in the dance, the authors regard the dance as deserving of greater attention than was hitherto the case in programs of physiotherapy, psychotherapy, and sociotherapy. From the existing essays at a therapy basing on body and motion, they infer basic common points, and to promote discussion, they state their attitudes in respect of the potential and rank of the dance in the concept of complex multimodal psychotherapy.     

Perversion and infancy and adolescence

Abstract

Studying the works of Freud and Lacan, the authors carried out research on perversion in childhood. Their work covered the perverse polymorphism of infantile sexuality and the perception of the anatomic difference between the sexes that leads the child to create sexual theories and fantasies. The phallic mother and the fetish are viewed as imaginary solutions directly related to the Oedipus and castration complexes. In perversion, a particular position is taken in relation to the Oedipus complex: a serious flaw occurs in the symbolization of the law, and the mechanisms of denial and disavowal take form. Sexuality requires a second “logical time,” separated from infancy by the latency period, in order to confirm (in action) that a fixed position of jouissance (enjoyment) has actually been established. This can only happen in a period after adolescent enhancement. The distinction between perverse traces and a perverse structure is made, taking into account the fact that, in the case of child analysis, the analyst should free the child from the family fantasy and help him/her to build his/her own fantasy.

Campos Santoro V. et al. Perversion und Kindheit und Adoleszenz.

Im Studium der Arbeiten von Freud und Lacan haben die Autoren Forschung über Perversion in der Kindheit gemacht. Die Studien behandeln den perversen Polymorphismus der infantilen Sexualität und die Wahrnehmung des anatomischen Unterschiedes zwischen den Geschlechtern, welche das Kind dazu führt, Sexual-Theorien und Phatasien zu schaffen.

Die phallische Mutter und der Fetisch werden als imaginäre Lösungen angesehen, die sich direkt auf den Ödipus- und Kastrations-Komplex beziehen. Bei der Perversion wird eine besondere Position in Bezug auf den Ödipus angenommen; ein ernsthafter Mangel tritt bei der Symbolisierung des Rechts auf; die Mechanismen der Verneinung und der Verleugnung bilden sich. Sexualität erfordert eine zweite “logische Zeit”, von der Kindheit durch die Latenz Periode getrennt, um (in der Handlung) zu bestätigen, daß eine fixierte Position der jouissance (Vergnügung) sich tatsächlich etabliert hat. Das kann sich nur in einer Periode nach der adoleszenten Verstärkung ereignen.

Es wird die Unterscheidung zwischen perversen Spuren und einer perversen Struktur gemacht, in Rechnung stellend, daß im Fall der Kinder-Analyse der Analytiker das Kind von der Familien-Phantasie befreien sollte und ihm/ihr helfen sollte, seine/ihre Phantasie auszubilden.

Campos Santoro V. Perversión e infancia y adolescencia.

Estudiando los trabajos de Freud y Lacan, los autores han investigado la perversión en la niñez. Los estudios cubren la sexualidad infantil perversa polimorfa y la percepción de la diferencia anatómica entre los sexos, que llevan al niño a crear teorías sexuales y fantasías.

La madre fálica y el fetiche son vistos como soluciones imaginarias relacionadas directamente con el complejo de Edipo y de castración. La perversión, toma una posición particular en relación al Edipo; un fallo importante tiene lugar en la simbolización de la ley; los mecanismos de negación y repudio toman forma. La sexualidad requiere un segundo “tiempo lógico” separado de la infancia por el periodo de latencia, para confirmar (en acto) que una posición fija de jouissance (goce) se ha establecido. Esto solo puede ocurrir en un periodo posterior a la intensificación adolescente.

La distinción entre las huellas perversas y la estructura perversa se ha hecho, teniendo en cuenta que, en el caso del análisis de niños, el analista debe librar al niño de la fantasía familiar y ayudar a el/ella a construir su propia fantasía.     

Yin and Yang,and the Hot and the Cold

Yin and Yang are important concepts in ancient Chinese philosophy.Western scholars have become more familiar with these two concepts recently,but for a long time almost no one considered comparing them with their own tradition such as the ancient Greek philosophy,and especially with the ideas of the Hot and the Cold in Presocratic philosophy.In this paper,I make an attempt to do exactly that,and especially make a detailed comparison between the thoughts of two ancient thinkers:Laozi and Anaximander.I discuss the thought of Yin and Yang in Laozi-who was the earliest philosopher making use of the concepts Yin and Yang-to express his cosmological thought in ancient Chinese philosophy.Comparatively,I discuss the ideas of the Hot and the Cold in Anaximander,the earlier among Presocratic philosophers referring to the Hot and the Cold as fundamental concepts used to establish his cosmological system.Through this comparison,I indicate that the similarity between ancient Chinese and Western traditions is far more significant than what people are used to imagining.     

Spirituality and Religiosity and Its Role in Health and Diseases

Religiosity is a factor involved in the management of health and diseases/patient longevity. This review article uses comprehensive, evidence-based studies to evaluate the nature of religiosity that can be used in clinical studies, thus avoiding contradictory reports which arise from misinterpretation of religiosity. We conclude that religiosity is multidimensional in nature and ultimately associated with inherent protection against diseases and overall better quality of life. However, a number of untouched aspects of religiosity need to be investigated further before we can introduce religiosity in its fully functional form to the realm of health care.