肢体严重毁损伤保留与否的循证思考

肢体严重毁损伤的修复是当今医学领域的一个研究热点。从循证医学角度对肢体严重毁损伤的保肢与截肢提出思考并加以阐述,同时结合当前我国医疗环境提出一些这方面的倡议。     

肢体延长与美容增高的启示

美容医学持续升温,"美容增高"即"肢体延长术"被越来越多的爱美男女所尝试.纵观其发展经历了许多挫折与失败,并发症多且严重,应慎重认识其实际效果.如不加选择地运用美容医学,是对医学核心价值体系的扭曲和嘲弄.只有坚持运用正确的哲学思维进行引导,肢体延长术才会健康发展.     

儿童创伤截肢

儿童意外伤害在国内外一直是受到普遍重视的问题,我国在这这方面的研究不多。严重肢体创伤的处理无论从专业理论还是在手术技巧上均要求很高,尤其对儿童肢体的毁损性创伤的治疗往往使临床医师常需在截肢与肢体挽救二者之间作出困难的选择。如何确定急诊截肢和保留肢体,国内外目前尚未有一个客观合理权威的标准。本文主要综述儿童截肢的标准和方法,以供参考。     

关于手术戒毒规范化开展的思考

吸毒成瘾是严重的医学和社会学问题.国内、外对吸毒成瘾采取的治疗方案由脱毒、防复吸和回归社会三个相互关联的方法构成.但收效甚微,复吸率居高不下.西安第四军医大学唐都医院神经外科在动物实验和借鉴以往经验的基础上,将立体定向技术用于毁损脑内与毒品心理依赖密切相关的关键位点的异常部分,对其异常功能进行调整,从而达到彻底戒毒的目的,取得了良好的疗效.本文介绍了手术戒毒在我国的发展历史,提出了规范化开展手术戒毒的建议.     

肢体延长与美容增高的启示

美容医学持续升温,“美容增高”即“肢体延长术”被越来越多的爱美男女所尝试。纵观其发展经历了许多挫折与失败,并发症多且严重,应慎重认识其实际效果。如不加选择地运用美容医学,是对医学核心价值体系的扭曲和嘲弄。只有坚持运用正确的哲学思维进行引导,肢体延长术才会健康发展。     

论医学人文属性复归的途径

医学本是自然科学和人文社会科学的统一体,但因历史和现实的诸多原因,导致医学中人文属性的严重缺失.分析了人文缺失的直接原因和深层根源,强调了医学人文社会属性的不可缺失性,提出了医学人文属性复归之途径.     

关于手术戒毒规范化开展的思考

吸毒成瘾是严重的医学和社会学问题。国内、外对吸毒成瘾采取的治疗方案由脱毒、防复吸和回归社会三个相互关联的方法构成。但收效甚微,复吸率居高不下。西安第四军医大学唐都医院神经外科在动物实验和借鉴以往经验的基础上,将立体定向技术用于毁损脑内与毒品心理依赖密切相关的关键位点的异常部分,对其异常功能进行调整,从而达到彻底戒毒的目的,取得了良好的疗效。本文介绍了手术戒毒在我国的发展历史,提出了规范化开展手术戒毒的建议。     

医学人性化的现实思考

当前,在医学领域尤其是临床医疗领域存在着严重的"人性淡漠"趋势,严重阻碍医学自身的健康发展,而且产生恶劣的社会影响.从医患关系、医学与人性的关系以及医学人性化的需求,深入剖析了医学人性化的重要性.     

医学创新之大忌:急功近利

急功近利是医学创新中的一种不良现象,给我国医学科学的发展带来了十分严重的后果.急功近利背离了正确的科学功利观,是对医学创新功利关系的严重错位.     

导言：创伤性截肢术简介

汶川大地震造成突发性、群体性肢体毁损。在救治工作中,为挽救部分患者的生命,接受伤员的医院对他们施行了截肢术。为配合医治此类伤员的需要,编辑部委托本刊编委秦泗河教授就此组织了一组文章。我们对秦泗河教授和各位撰文的专家表示衷心的感谢!     

高校辅导员的边界分割偏好与工作-非工作冲突:边界分割管理策略的调节作用

采用问卷调查法,对312名高校辅导员进行调查,探讨边界分割偏好、组织分割供给和个人边界分割策略与工作-非工作冲突的关系。结果表明:(1)辅导员的边界分割偏好与工作-非工作冲突正相关;(2)组织分割供给和个人边界分割策略均能减弱边界分割偏好与工作-非工作冲突之间的正相关。本研究提示高校应在不影响工作的前提下尽量向辅导员提供更多的组织分割供给,同时辅导员也可以通过灵活运用边界分割策略,进行自主的工作-非工作边界管理。     

On Disjunctive Rights

This article examines the idea of disjunctive rights—an idea first suggested by Joel Feinberg and more recently advocated by Richard Arneson. Using a hypothetical scenario to bring forward a conflict between two rights that cannot be simultaneously fulfilled, the suggestion that the conflict can be solved by describing the right‐holders as holding disjunctive rights—rights that involve, in a significant way, a disjunction—is scrutinized. Several interpretations of the idea of disjunctive rights are examined from the perspectives of the interest theory and will theory of rights. Ultimately, the idea of disjunctive rights fails to provide an acceptable solution to the problem at hand, as each interpretation has unacceptable implications. This conclusion challenges the compossibilist thesis, according to which moral rights do not, ultimately, conflict. Alternatively, if one wishes to keep the possibility of compossibility and disjunctive rights, the mainstream theories of rights must be revised or rejected.     

The right to practice medicine without repercussions: ethical issues in times of political strife

ABSTRACT: This commentary examines the incursion on the neutrality of medical personnel now taking place as part of the human rights crises in Bahrain and Syria, and the ethical dilemmas which these incursions place not only in front of physicians practicing in those nations, but in front of the international community as a whole.In Bahrain, physicians have recently received harsh prison terms, apparently for treating demonstrators who clashed with government forces. In Syria, physicians are under the same political pressure to avoid treating political demonstrators or to act as informants against their own patients, turning them in to government authorities. This pressure has been severe, to the point that some physicians have become complicit in the abuse of patients who were also political demonstrators.This paper posits that physicians in certain countries in the Middle East during the "Arab Spring," specifically Syria and Bahrain, are being used as both political pawns and political weapons in clear violation of Geneva Convention and World Medical Association guidelines, and that this puts them into the most extreme sort of "dual loyalty" dilemma. They are being forced to choose between their own safety and well-being and that of their patients -- a negative sum scenario wherein there is no optimal choice. As such, an international call for a United Nations inquiry must be made in order to protect the neutrality of medical care and personnel during times of armed conflict.     

Conflicts of interest in science and medicine: the physician's perspective

The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of conflict of interest that can arise in the practice of medicine are outlined. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The World Medical Association (WMA) is a global federation of National Medical Associations representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavours to achieve the highest possible standards of medical care, ethics, education and health-related human rights for all people.     

基于Flanker、Stroop和Simon多重冲突驱动的认知控制机制

认知控制是维持和调整多任务目标导向的加工策略,而基于多任务冲突的认知控制是一般领域上还是特定领域上,即一种冲突是否会影响另一种冲突的解决,已有研究并没有得到统一的结论。本研究运用事件相关电位（ERP）方法考察了同一任务中不同类型冲突（Stroop、Simon和Flanker冲突）驱动认知控制调节的脑机制。数据显示：各冲突都出现了一致性效应和冲突适应性效应;实验中每种冲突的上一个trial只与该类冲突的当前trial的交互效应显著,而与其他类型冲突的当前trial的交互效应不显著;几乎所有冲突都发现了P300、N450、SP成分一致性效应。结果表明：在不同类型冲突驱动条件下,人脑能够同时监控并解决不同类型的冲突;冲突驱动的认知控制系统以局部的控制方式工作;人脑是基于多冲突驱动的认知控制系统的灵活性和某类型冲突所特有的控制机制来解决冲突,且冲突解决机制是相互独立、互不干扰的。     

When Is It Ethical for Physician-Investigators to Seek Consent From Their Own Patients?

Classic statements of research ethics advise against permitting physician-investigators to obtain consent for research participation from patients with whom they have preexisting treatment relationships. Reluctance about “dual-role” consent reflects the view that distinct normative commitments govern physician–patient and investigator–participant relationships, and that blurring the research–care boundary could lead to ethical transgressions. However, several features of contemporary research demand reconsideration of the ethics of dual-role consent. Here, we examine three arguments advanced against dual-role consent: that it creates role conflict for the physician-investigator; that it can compromise the voluntariness of the patient-participant’s consent; and that it promotes therapeutic misconceptions. Although these concerns have merit in some circumstances, they are not dispositive in all cases. Rather, their force—and the ethical acceptability of dual-role consent—varies with features of the particular study. As research participation more closely approximates usual care, it becomes increasingly acceptable, or even preferable, for physicians to seek consent for research from their own patients. It is time for a more nuanced approach to dual-role consent.     

Gene Patents: A Broken Incentives System

The proliferation of patents on human genes has raised important ethical questions centered on the conflict of patient rights and intellectual property rights. With the Supreme Court’s June 2013 decision that altered the patent eligibility of genetic material, it is important to reexamine the ethical implications of gene patents as a concept. Such patents suggest an ownership of genetic material that may hinder access to healthcare and inhibit medical progress. The application of the current patent system to genetic material thus violates patients’ rights without fulfilling the system’s goal of promoting innovation, suggesting a need for a revised incentives infrastructure.     

The Religious and Social Principles of Patients’ Rights in Holy Books (Avesta, Torah, Bible, and Quran) and in Traditional Medicine

Health protection and promotion in healthy people and restoring patients’ health have been the most important themes in medicine and health throughout our history. Therefore, discussion of different aspects of patients’ rights includes implementation of these objectives by the medical community, including physicians, nurses, pharmacists, etc., and the people in charge of health affairs. The principal objective of our research is the study of medical ideology and the approaches of our ancestors in relation to different aspects of patients’ rights. To study the different ideologies of traditional medicine in relation to patients’ rights, appropriate data were extracted from the original resources of traditional medicine and from religious books. By means of library research we studied these resources in addition to electronic versions of the Alhavi book (by Rhazes), the Kamel-al-Sanaah (by Ahvazi), the Canon of Medicine (by Avicenna), the Zakhireye Khawrazmshahi (by Jorjani), the Avesta, the Torah, the Bible, the Quran, and many other resources, and, finally, after searching, gathering, and encoding the findings, analyzed them qualitatively for thematic content. The holy Avesta book clearly insists on the competence of physicians and setting the appointment fee in accordance with peoples’ income. The Old Testament (holy Torah) warned government officials who did not observe patients’ rights. In the four gospels (holy Bible) the importance of treatment and taking care of the patient is stressed. After the emergence of Islam, medical students, before beginning the principal courses, had to study Islamic jurisprudence, ethics, logic sciences, natural sciences, geometry, astrology, calculus, and similar courses so that after purifying their soul they could enter the saintly profession of physicians. The holy Quran refers to saving the life of a human irrespective of social class, race, and religion, and insists on exemption of patients from physical activity, including the physical aspects of prayer. In these resources, some warnings are offered in relation to fake drugs, the lack of awareness of some physicians, the need for complete preparedness of medical society, and the need to manufacture appropriate drugs and offer a suitable medical service. This information is to familiarize medical and health authorities and persons receiving health services. According to the evidence available about traditional medicine, there was no specific difference between public and professional ethics, public and professional rights, or rights and ethics—ethics were no different from rights nor rights from ethics. So ethics are similar to the soul in the body of rights, and rights are similar to the litter of ethics, and they have developed in parallel with each other. Traditional medicine is community-based and preservation of the health of healthy people is given priority over the treatment of patients; there is insistence that “health rights” has wider scope than “patients’ rights”. It can be stated that health rights in Iran both before and after the emergence of Islam have been based on guidance from divine religions, observation of humanist ethics, passing suitable courses in the basic sciences, and an introduction to the practical piety of our ancestors, in addition to the syllabus of medical and health education.     

医护人员对患者权利的保护情况调查分析

采用现场问卷方式调查统计结果表明:大部分医护人员了解患者的相应权利,对患者权利具有一定的保护意识,但部分患者权利保护不足,存在易发生医患纠纷隐患,需要引起临床医护人员的重视,不断加强法制观念教育.     

浅论医患关系中的权利冲突——以医师的诊疗权与患者的知情同意权为例

现实中医患关系呈现给人们的似乎是永远纠缠不清的利益,掩盖了医惠之间模糊的、缺失的权利。实质上引发医患矛盾的主要原因不是利益而是权利的冲突,从医师的诊疗权与患者的知情同意权的角度出发,分析了医患关系中权利冲突的成因及其表现,提出了相关解决的方法。