从大肠癌诊疗看医学整合

过去的几十年里,在全世界范围内关于大肠癌的预防和治疗在不断地综合发展,如今治疗结直肠癌的方式不仅仅局限于外科的手术切除治疗。结直肠癌已经成为了一种需要应用预防、内科、外科和姑息治疗相结合的方式进行治疗的疾病。因此,通过多学科途径进行大肠癌的预防和治疗非常必要。在很大程度上,目前应用的诊治技术正在逐步应用于大肠癌的早期诊断和个体化治疗,这将是医学不可避免的发展趋势。     

从医师的视角浅析医疗差错的辩证观

医疗差错是影响医疗安全的最重要因素。有效预防和正确处理医疗差错,需要以科学辩证的认识为前提。当前,我国医院管理实践在一定程度上缺乏对医疗差错的辩证认识,导致在处理上存在些许不足。本文从医师的视角,对如何辩证地认识医疗差错进行浅述。指出,医疗差错在相当程度上源于人的出错之天性和医学的复杂性,广泛存在于医疗实践中,发生具有必然性;虽然从表象上看,医疗差错的原因是局部的,但其本质的原因是系统性的;医疗差错是医疗安全系统运行状况的"指示灯",有助于及时地了解安全系统的薄弱环节,为完善和提升系统安全、提高医疗服务水平提供契机。     

如何书写好内科病历

病历是医疗活动的原始记录或历史记载,是最准确,可信的记录。在现代医院管理中,病历作为医疗活动信息的主要载体,不仅是医疗、教学、科研的第一手资料,而且也是综合评价医院医疗质量、技术水平、管理水平的依据。即病历质量好坏体现医生的学术和品德,体现医院的管理水平和医疗质量。病志书写的水平,是一位医生理论基础、技术水平、临床经验、表达能力、逻辑思维的综合检验。然而现在有些病历,特别是大医院的病历质量不高的原因是工作太忙,病人太多。下级医师对疾病特点了解不够,概念不清楚。上级医师要养成习惯把您心里想的思路说出来,以提问的方式讲更好,这样对下级医生的印象会更深,同时也可以掌握他们是否理解正确了,督促下级医生平时的学习,始终要抓"三基三严",强调临床基本功。本文把内科病历书写中的常见问题一一列出,并具体指导如何改进。     

浅析整合型医疗卫生服务系统

整合型医疗卫生服务系统是由医疗卫生服务机构通过自建、并购或签订合约等方式实现水平和垂直式整合后,所形成的为患者提供整合型卫生服务的系统。它遵循"以患者需求为中心"的理念,对于促进卫生资源的合理配置和利用,提高我国卫生服务的公平、效率和可及性具有十分重要的现实意义。     

Domain generality and domain specificity in aesthetic appreciation

Aesthetic appreciation is looked at with respect to domain generality and domain specificity. Within the classic cognitive paradigm, modality- and domain-specific receptive processes are explored. These are then complemented with central processing structures. These reveal domain-specific as well as domain-general processing. Extending the classic cognitive science approach, the role of emotion in aesthetic appreciation is also explored. While domain-specific models of aesthetic appreciation are clearly called for, there are also numerous domain-general subprocesses and structures.     

浅析医生处方权的属性与规范——基于医疗卫生资源微观配置视角的分析

从医疗卫生资源微观配置视角分析,处方权是一种资源配置权力,属于公权力。主要分析了医生处方权的权力来源、医生处方权的职权性质和医生处方权的源权力属性。鉴于此,建立处方权独立行使的保障制度与处方权规范行使的程序控制制度可以有效规范医生处方权的行使。     

一个妊娠急性脂肪肝病例引发的思考

从一个妊娠急性脂肪肝病例的诊断和治疗过程中,认识到在临床实践中认真细致的观察,突破思维定势开拓创新的重要性。并体会到医疗风险问题制约着医护人员主观能动性的发挥,如何采取防范措施值得深思。     

Teaching medical staff psychological concepts via a hospital newsletter

Despite the increased recognition of the critical role of social and psychological factors in health and illness, the teaching of psychology is rarely integrated in medical education. Staff generally have minimal formal training in psychological concepts. Patients on the inpatient rehabilitation unit frequently present with unexpected reactions in response to acute trauma and resulting changes in identity and capabilities. Rehabilitation goals therefore, must be based on psychological, as well as physical, capacities. A one-page, user-friendly newsletter was designed to illustrate basic psychological principles via case vignettes. The topics of fear, countertransference, and resistance were selected as critical issues staff frequently encounter in their work with patients. The newsletters provided the staff with basic conceptual tools for effectively treating patients, and the work of psychologists was demystified. The newsletter format is proposed as a creative adjunct to didactic teaching.Copies of the newsletter Insight can be obtained by request from Dr. Gold.     

Teaching psychological knowledge and skills to family physicians

Psychological problems (e.g., anxiety, depression, substance abuse) are prevalent in primary care medical settings. Family physicians (FPs) treat more patients than any other primary care medical specialists. Thus, FPs can play an extremely important role in providing psychological services to their patients. In contrast to other specialists (e.g., internists, obstetricians), FPs are required to complete behavioral science training in their residencies. In this paper, we describe standard undergraduate, graduate, and postgraduate training of FPs. We present our unique program for teaching psychological principles and skills to family practice residents at the University of Kansas Medical Center. And finally, we introduce an instrument, the Interview Rating Scale (IRS), for evaluating the interviewing skills of physicians and residents.