波前相差引导的个体化切削治疗近视

角膜的个体化切削是在PRK、LASIK、LASEK的基础上发展起来的一种新的屈光手术技术。其最大的优点是根据不同眼的特点对角膜进行切削,使其达到最佳的视觉效果。现回顾角膜屈光手术的发展,并运用哲学原理对个体化切削的依据、技术创新及其具体应用加以综述。     

科学技术发展与角膜屈光手术的研究进展

角膜屈光手术是自20世纪50年代开始出现,由最初的冷冻角膜磨镶术到PRK、LASIK、个体化切削,伴随着科学技术的发展和进步,新技术的不断涌现并应用于临床,角膜屈光手术也日新月异,手术安全性、预测性有了极大提高.今天,角膜屈光手术已经极大地改变我们的生活,显示出科学技术的强大力量.本文就科学技术的发展对角膜屈光手术的促进和影响作一概述.     

个体化角膜屈光手术的探讨

对个体化角膜屈光手术这一屈光矫正领域的新理念和新方法进行探讨,提出医务工作者要勇于思想创新;以辩证思维看问题;关注社会需求,正确处理以人为本与追求经济利益的关系;加强多学科交叉合作和复合型人才的培养,才能推动个体化角膜屈光手术不断向更高层次迈进.     

个体化角膜屈光手术的探讨

对个体化角膜屈光手术这一屈光矫正领域的新理念和新方法进行探讨,提出医务工作者要勇于思想创新;以辩证思维看问题;关注社会需求,正确处理以人为本与追求经济利益的关系;加强多学科交叉合作和复合型人才的培养,才能推动个体化角膜屈光手术不断向更高层次迈进。     

角膜屈光手术治疗的综合启示

角膜屈光手术是近年发展起来的治疗屈光不正的重要技术.已应用于临床,并取得了令人鼓舞的结果.尤其是准分子激光的实时扫描跟踪技术,并辅之眼前段成像系统与波前相差技术的一体化,极大提高了手术疗效.纵观其发展过程,认识到角膜屈光手术的发展是多学科联合发展的结果.     

波前像差仪与主觉验光的临床比较

随着个体化屈光手术的发展,波前像差仪越来越多地出现在临床检查中,其主要应用为术前高阶像差检测,以提供个体化手术的切削方案以及观察术后术眼的高阶像差改变情况.本文是针对波前像差仪能够对低阶像差进行测量的功能,经过对不同度数组患者的波前像差仪的低阶像差检测结果与其主觉验光的结果进行比较,发现两者之间有较好的相关性.     

角膜屈光手术治疗的综合启示

角膜屈光手术是近年发展起来的治疗屈光不正的重要技术。已应用于临床,并取得了令人鼓舞的结果。尤其是准分子激光的实时扫描跟踪技术,并辅之眼前段成像系统与波前相差技术的一体化,极大提高了手术疗效。纵观其发展过程,认识到角膜屈光手术的发展是多学科联合发展的结果。     

波前像差仪与主觉验光的临床比较

随着个体化屈光手术的发展,波前像差仪越来越多地出现在临床检查中,其主要应用为术前高阶像差检测,以提供个体化手术的切削方案以及观察术后术眼的高阶像差改变情况。本文是针对波前像差仪能够对低阶像差进行测量的功能,经过对不同度数组患者的波前像差仪的低阶像差检测结果与其主觉验光的结果进行比较,发现两者之间有较好的相关性。     

现代科学技术与角膜屈光性手术的发展

通过回顾角膜屈光性手术的发展历史,从中可以看出角膜屈光性手术的发展过程是一个实践－认识－再实践－再认识的过程,相关学科的进步以及新科技的引进,是认识的不深化以及实践的理论和物质基础,激光,电子计算机,材料学及制作工艺等现代科学技术的进步在角膜炎屈光性手术发生中起了决定性的作用。     

计算机模拟技术在漏斗胸治疗中的应用

NUSS手术是矫治儿童漏斗胸畸形的首选方法,但目前对制定个体化手术和评估术后矫形效果尚缺乏科学的手段.以有限元分析法为基础的计算机三维成像技术能模拟NUSS手术术后矫形效果,测算钢板的数量、塑形和置入部位及胸廓应力状态,预计手术并发症的发生.计算机模拟技术可为减少手术风险,制定科学的个体化NUSS手术提供有效的指导.     

Community-Based Interventions: A Return to Community Mental Health Centers' Origins

Consultation services offered by community mental health centers (CMHC) have gone through several significant changes since the signing of the Community Mental Health Center Act of 1963 (The President's Commission on Mental Health, 1978). Initially, consultation and education services were an integral part of the CMHC mission. With the passage of additional legislation that promoted a shift in focus, consultation services declined. By 1981, with the passage of the Omnibus Budget Reconciliation Act (Cutler, 1992) national mental health policy was adrift. Consultation and education were no longer seen as central components of mental health services, which increasingly were tied to acute care hospitalization. With a renewed focus on consultation and education, a coherent mental health policy can be reintroduced at the community level.     

卫生经济伦理学对医疗完全市场化的质疑

不管处于什么发展水平的国家,都需要进行持续的卫生保健改革,这已成为整个社会政治改革的一部分,卫生保健改革已经融入整个世界的社会大变革中。卫生经济问题无一不具有道德成分,无一能离开伦理政策得以解决。我们对中国医疗卫生体制改革的伦理学展望中,提倡一种“公平优先,兼顾效率”的价值观。我们需要正确认识市场的目标、价值和规律,正确理解和发挥政府和市场的调节作用,促进医疗卫生体制改革的健康发展。     

医疗保障制度改革过程中的价值取向问题及其影响

随着社会主义市场经济体制的建立,我国传统的劳保医疗制度和公费医疗制度已越来越不适应社会发展的要求,呈现出诸多弊端,亟待改革。作为一项公共政策,医疗保障制度在改革与完善的过程中应根据科学行政的要求对政策的价值取向进行深入分析,以便顺利实施改革的各项方案。分析医疗保障制度改革中所涉及的各方面的价值观及其对改革的影响,希望唤起政策制定者对不同群体利益的关注,从而保证政策体系的稳定。     

政府与个人的责任——中国当代医疗改革的责任伦理学剖析

卫生改革的重点必须放在政府部门;公共卫生,预防与初级医疗保健是人类生存的需要,带有鲜明的公益性和福利性。应由政府投资为主筹集资源,以国家投资为主体负担费用,这个层次的卫生服务产品,属非商品经济部分,并不以赢利为目的,不能引进市场经济,个人对健康负有重要责任,包括：选择医疗保健,决定花费数额,生活方式和卫生习惯的养成,主动接受健康教育,抵抗压力,支持国家与地区的卫生保健政策;个人对自身健康负责是一种道德责任,健商（health quotient)这一重要概念,具有伦理价值和普遍的医学人类学意义;个人对健康负责是一种社会风尚。     

Future Directions for Health Promotion Program Development in Schools

Many schools will develop health promotion and disease prevention programs during this decade. Because of the rapidly changing nature of these programs, it is helpful to consider the major issues that will have an impact on health promotion program development. These issues include: (1) increased wellness focus; (2) improved database for planning; (3) computerized assessment procedures; (4) prioritized market segments; (5) standardization of service protocols; (6) confluent appraoches; (7) role delination for the school health team; (8) staff development programs; and (9) program evaluation.     

公共卫生领域非传统安全威胁及应对

医学公共卫生领域非传统安全威胁历来是而且当今仍然是威胁人类自身生存的重大社会安全问题.重大传染病的暴发、自杀、现代医学高科技等现象动辄呈现出全球化趋势,尤其是SARS的爆发,突出了公共卫生的重要性,给我国公共卫生的管理及政策制定提出了更高要求:应真正建立起以"预防为主"的公共卫生体系,加强中国与国际的安全合作,加强公民的医学和健康教育.这是由公共卫生本身的性质和时代的发展共同决定的.     

卫生政策走向与公共健康及其伦理思考

政府通过决策决定卫生政策,卫生政策对于公共健康具有导向和引领作用。卫生政策走向直接影响公共健康,决定公共健康的发展方向。卫生政策与公共健康的关系是因果关系,前者决定后者。卫生政策需要有伦理学基础和伦理学专家的伦理论证,坚持公正、公平、公益的原则。     

公共卫生与全民的健康意识

SARS事件使公共卫生和全民的健康意识问题成为全社会的焦点问题,现在人们更加关注的是后SARS时代我国公共卫生建设和全民健康意识喜忧参半的现状,也许更有意义的是探讨公共卫生与全民健康意识的关系,明确健康意识的内涵,认清民众的健康误区,重视全民的健康教育.     

Is Health (Really) Special? Health Policy between Rawlsian and Luck Egalitarian Justice

In recent work, Norman Daniels extends the application of Rawls's principle of ‘fair equality of opportunity’ from health care to health proper. Crucial to that account is the view that health care, and now also health, is special. Daniels also claims that a rival theory of distributive justice, namely luck egalitarianism (or ‘equal opportunity for welfare’), cannot provide an adequate account of justice in health and health care. He argues that the application of that theory to health policy would result in an account that is, in a sense, too narrow, for it denies treatment to imprudent patients (e.g. lung cancer patients who smoked). In a different sense, Daniels argues, luck egalitarian health policy would be too wide: it arguably tells us to treat individuals for such brute‐luck conditions as shyness, stupidity, ugliness, and having the ‘wrong’ skin colour. I seek to advance three claims in response to Daniels's revised theory, and in defence of a luck egalitarian view of health policy. First, I question Daniels's assertion regarding the specialness of health. While he is right to abandon his insistence on the specialness of health care, it is doubtful that health proper can be depicted as special. Second, I try and meet Daniels's objections to luck egalitarianism. Luck egalitarian health policy escapes being too narrow for it does not in fact require denying basic care to imprudent patients. As for it being allegedly too wide, I try to show that it is not, after all, counterintuitive to rid individuals of unfortunate and disadvantageous biological traits (say, a disadvantageous skin colour). And third, I question whether Daniels's own Rawlsian account is in fact wide enough. I argue that fair equality of opportunity fails to justify some standard medical procedures that many health systems do already practice.     

Why 'Health' is not a Central Category for Public Health Policy

We normally think that public health policy is an important political activity. In turn, we normally understand the value of public health policy in terms of the promotion of health or some health-related good (such as opportunity for health), on the basis of the assumption that health is an important constituent or determinant of wellbeing. In this paper, I argue that the assumption that the value of public health policy should be understood in terms of health leads us to overlook important benefits generated by such policy. To capture these benefits we need to understand the ends of public health policy in terms of the promotion of 'physical safety'. I then go on to argue that the idea that 'health' is an important category for evaluating or estimating individuals' wellbeing in the normative context of social policy is confused. I then clarify the relationship between my arguments and QALY-based accounts of health assessment. In the final section of the paper, I defend this surprising conclusion against various attacks.