"以病人为中心"医疗服务模式的理念与发展

纵观20世纪医疗服务的发展历程,医疗服务的发展经历了“以疾病为中心”的传统医疗服务模式到“以病人为中心”的新的医疗服务模式的转变;目前,以“以病人为中心”的医疗服务模式已经成为我国现代医院改革与发展的主题。因此,在阐述医疗服务模式变革与发展的基础上,系统论述了“以病人为中心”的医疗服务模式的内涵与特点,新的理念、新的认识,也带来了新的希望,新的医疗服务模式将不断地改善与提高人们的健康状况与生活质量。     

全面正确理解和实行以病人为中心的思想

近两年在逐渐深化的医疗改革中提出了以病人为中心、一切为了病人的口号 ,突出地体现了党和国家对人民群众生命健康的关注 ,因此如何全面准确地理解以病人为中心的思想不仅关系到每一位病人的健康和疾病 ,同时也关系到整个中华民族的健康和中国现代医学事业发展问题。1　贯彻以病人为中心原则应强调医患之间沟通 ,尽快实现从传统的生物医学模式向生物心理社会医学模式的转变在以疾病为中心的医疗服务模式中医生完全从生理学的观点来解释疾病的变化 ,着重于疾病的诊断与治疗 ,而没有将患者视为完整的个体。Ｂ .Ｅｎｇｅｌ博士曾指出 :“传统…     

医学整合:专科与综合医疗小组结合模式的探索

生物医学在推动人类健康的道路上出现的专科化弊端日益显著。整合医学以将医学各领域的知识理论和各专科的实践经验加以整合,使医学更加适合人体健康和疾病治疗的优势,受到人们关注。但由于整合医学缺乏具体操作模式等困难,发展缓慢。对比分析以上两种医疗模式后提出专科化医学与综合医疗小组相结合的具体医疗模式,该模式具有减少漏诊、误诊率,减少医患纠纷,保证医学发展,控制医疗费用等优势。由于我国慢性病人群增多,医患矛盾激化,人们对于卫生资源的需求增加,这种新模式是未来医疗模式的发展方向。     

医院内部风险基金制度与病人安全初探

医疗活动本身存在着不确定性和相对确定性一对内在矛盾,由不确定性引发的医疗过失等是影响病人安全的主要因素。在目前以医院为管理主体的前提下,建立医院内部风险基金制度,提高医务人员的执业风险意识,减少医疗过失的发生,是保障病人安全的一种尝试。     

医院内部风险基金制度与病人安全初探

医疗活动本身存在着不确定性和相对确定性一对内在矛盾,由不确定性引发的医疗过失等是影响病人安全的主要因素.在目前以医院为管理主体的前提下,建立医院内部风险基金制度,提高医务人员的执业风险意识,减少医疗过失的发生,是保障病人安全的一种尝试.     

倏忽与浑沌和中医与西医

中医“科学化”和“现代化”是西方医学传入我国一百多年来几代中医人的夙愿和奋斗目标,但在以感染和传染性疾病为主要矛盾的生物医学模式阶段,却一直难以取得突破性的进展。随着各种慢性疾病发病率的逐年增加、医疗重点的转移和生物-心理-社会医学模式的确立,中医的现代化发展正在面临着前所未有的机遇和挑战。借助《庄子》“倏忽为浑沌开窍”的故事,重点就新的医学模式下的中医现代化发展进行了一些方法论的探讨。     

倏忽与浑沌和中医与西医

中医"科学化"和"现代化"是西方医学传入我国一百多年来几代中医人的夙愿和奋斗目标,但在以感染和传染性疾病为主要矛盾的生物医学模式阶段,却一直难以取得突破性的进展.随着各种慢性疾病发病率的逐年增加、医疗重点的转移和生物-心理-社会医学模式的确立,中医的现代化发展正在面临着前所未有的机遇和挑战.借助<庄子>"倏忽为浑沌开窍"的故事,重点就新的医学模式下的中医现代化发展进行了一些方法论的探讨.     

台湾《安宁缓和医疗条例》的通过及随想--台湾的安宁疗护介绍之二

目前,台湾每年约有11万名临终病人.如何为这些临终病人提供满意的服务,是台湾地区医疗机构面临的一项重要任务,也是他们需要解决的一个现实问题.为了促进安宁缓和医疗的发展,尊重不可治愈末期病人之医疗意愿及保障其权益,台湾立法院于2000年5月23日通过三读,通过了<安宁缓和医疗条例>,并于2000年6月7日正式公布.这个条例的通过,为台湾临终病人提供了一种新的选择.不遗余力地推动这个条例的赵可式博士(台湾大学护理系副教授),当场兴奋地落下泪来.这个条例的主要内容有如下一些:     

病人自主权：未来医患关系的根本立足点

病人自主权是病人人格、尊严的重要内容。尊重病人自主权是医疗服务的最高境界,是医疗和医患关系新的立足点。在未来医疗中,提高病人权利意识,鼓励和帮助病人自主,给病人更多自主选择和决定的机会,应该是医院和医务工作者义不容辞的责任。     

生物医学工程:医学工程思维的人文困惑

生物医学工程引入新的人文问题.其认识主体、认识角度和学科范围都是基于工程的,实质是工程对医学的改造."医学工程共同体"改变了医师结构和群体,使"医惠关系"复杂化."机器"思维使医学有变为"机器医学"的危险.生物医学工程加剧以"身心二分"为特点的当代医学人文困惑.     

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.