辽宁省临床医师认知和使用循证医学情况调查

为了解临床医师使用循证医学(Evidence-Based Medicine)的知晓度,获得基线资料,为卫生部门提供决策依据,课题组对辽宁省三级甲等医院的243名临床医师采用问卷调查.结果显示,临床医师受经验医学的束缚,未能将循证医学运用到医疗实践当中.为提高我国临床医学水平,在临床医师中推广循证医学非常必要.     

辽宁省临床医师认知和使用循证医学情况调查

为了解临床医师使用循证医学(Evidence-Based Medicine)的知晓度,获得基线资料,为卫生部门提供决策依据,课题组对辽宁省三级甲等医院的243名临床医师采用问卷调查。结果显示,临床医师受经验医学的束缚,未能将循证医学运用到医疗实践当中。为提高我国临床医学水平,在临床医师中推广循证医学非常必要。     

急诊临床思维的特异性

笔者通过日常工作的经历,分析急诊工作的性质,归纳总结了急诊工作四大特点,即危、急、重、杂.提出急诊临床思维具有很强的特异性,由此演绎了12种思维形式.为急诊医师快速而合理地做出临床决策,提高工作质量,保证医疗安全,减少医疗纠纷或事故提供参考.     

临床决策与疾病发展的“度”

临床决策是十分复杂的专业劳动,良好而科学的临床决策取决于众多因素,包括医师的临床经验、知识水平、医师的爱心与责任心、患者病情的复杂性、医疗水平与条件、患者及家属的条件与配合程度等等,辩证法的“度”在临床的良好应用会帮助医师准确地把握病情,给予更加适度治疗;真正的个体化临床决策必须由医师与患者及家属的密切配合才能实现。     

临床决策论坛版栏目设置及撰文要求

经多方筹划和政府有关部门批准,《医学与哲学》杂志的一个新面孔——“临床决策论坛版”,和读者见面了。为使这个版本能够真正反映临床的实际需要,切实成为临床医师的讨论、交流临床实践中各种问题的场所和园地,实现诊治水平的最优化、个体化,我们热切地希望广大临床医师踊跃为     

临床决策论坛版栏目设置及撰文要求

经多方筹划和政府有关部门批准,《医学与哲学》杂志的一个新面孔———“临床决策论坛版”,和读者见面了。为使这个版本能够真正反映临床的实际需要,切实成为临床医师的讨论、交流临床实践中各种问题的场所和园地,实现诊治水平的最优化、个体化,我们热切地希望广大临床医师踊跃为本刊撰文。现将该版本的栏目设置和文章要求告知如下:医学评论:对医学特别是临床医学的新进展、新动向、疗效判定(含中医、西医、中西医结合)、临床科研、医疗作风进行评论。临床决策研究:本栏目主要就临床决策中的各种理论和实际问题进行探讨。如:对一个病人的治…     

循证医学与临床急诊

循证医学的定义为“慎重、准确和明智地应用所获得的最好研究依据来对患者的处理作出决策”。可见循证医学的出发点是以“证据”为基础。急诊科医生运用循证医学指导临床 ,首先要改变以往的诊治理念 ,要在过去凭医生的经验、急诊化验等作出的决策的基础上 ,要将个人的临床经验与现有的最可靠的临床证据结合起来。这一证据主要是指包括病因、诊断、治疗、康复和预后等方面的研究”。急诊科的特点是突出一个“急字”。即“病人急、病情急、病人家属急、医生急。 (医生急只能在思想上、行动上急 ,在情绪上不能急 )。有的医生可能认为这样一个工…     

急诊医学临床教学现状与对策

急诊医学是一门新兴的跨专业临床学科,在临床教学方面存在诸多不足.因此对于如何提高急诊医学的临床教学质量,完善临床教学方法就尤为重要.本文结合急诊医学的特点与临床带教中常遇到的问题,对如何提高学生解决问题的能力以及提升临床教学水平进行探讨.     

沿着26年的足迹,再创《医学与哲学》杂志辉煌欢迎为"临床决策论坛版"撰文临床决策论坛版征文启事

经多方筹划和政府有关部门批准，《医学与哲学》杂志的一个新面孔——“临床决策论坛”，不久即将和读者见面了。为使这个版本能够真正反映临床的实际需要，切实成为临床医师的讨论、交流临床实践中各种问题的场所和园地，实现诊治水平的最优化、个体化，我们热切地希望广大临床医师踊跃为本刊撰文。现将本版本的栏目设置和文章要求告知如下：     

循证医学在神经外科临床决策中的应用

在神经外科复杂的诊治实践中,需要循证医学的方法不断提高临床决策水平。本文从神经外科的角度对循证医学在临床决策中的应用进行了分析和探讨。     

异位妊娠临床诊疗中的策略与决策

通过异位妊娠的发病率,诊断及治疗中的注意事项,治疗方法的选择的分析,探讨异位妊娠的临床诊断及治疗的策略与决策。为了提高异位妊娠的诊断率、减少误诊率,需要建立合理的临床思维方法和科学的处理程序,为异位妊娠的临床诊断及治疗,提供科学的临床决策方法。     

借助巴林特小组培训模式提高临床护理质量

通过对巴林特小组培训模式的认识和理解,并将之运用于临床护理研究,使护理人员在处理护患关系中形成新的视角和更具分析性的思考方式,从而能够更深刻地意识到自身对于患者的影响,提高换位思考的敏感性,以便更好地理解和帮助患者;同时还能促进护理人员的心理健康和减少其工作中存在的护患矛盾。这不仅可以提高患者的治疗效果和生活质量,而且还可以提升护理人员自身的职业素养。因此,巴林特小组培训模式对于实现临床护理优质服务具有重要的现实意义。     

践行患者受益的基本原则——从累及泌尿生殖系统复杂子宫内膜异位症临床处置谈起

“患者受益”作为临床处置决策的基本原则在日常的医疗工作中发挥着积极的作用。同样也在常见类型子宫内膜异位症（EM）诊疗过程中得到很好地贯彻执行。然而,对于少见的累及泌尿系的EM,由于缺乏可靠的临床循证医学证据用以指导患者具体的临床处理,把握患者利益最大化原则就显得尤为重要。怎样掌握累及泌尿生殖系子宫内膜异位症患者临床处置决策中的关键要素,尽可能为患者保留生殖能力与泌尿系统的完整性,以提高日后的生活质量。除需要详细了解患者病史特别是手术史、盆腔影像学检查、肾脏功能评估结果外,选择个性化的干预手段并对预后进行综合评估,制定最为适合的治疗方案是至关重要的。本文结合临床典型病例就此问题做一剖析。     

国外临床决策研究进展（上）

2004年～2010年国际医学决策学会年会,提出许多与临床相关的决策问题,其中包括健康经济学与成本效益分析,临床方法学研究进展,医患双方的临床决策选择,公共卫生服务研究和诊疗策略的关系,临床策略与治疗指南,高新技术与适宜技术等。本文就以上问题,尤其是临床决策研究热点,对国外临床决策研究进展进行总结、探讨和评价,为临床应...     

The Identification of Selling Abilities Needed for Missionary Type Sales

This field study using salespeople, sales managers, and physicians identified 14 abilities necessary for successful pharmaceutical salespeople, the prototypical missionary sales position. Six of the abilities were identified by all three parties and make up the core requirements while one ability was recognized by physicians and not the other two groups. Finally, this research offers suggestions, based on the 14 identified abilities, for recruiting and sales training efficiencies to improve salesperson performance.     

腹主动脉瘤的外科治疗决策

腹主动脉瘤破裂是最常见、最凶险的疾病之一。提高对其治疗的临床决策水平至关重要。比较传统开腹修复治疗和血管腔内修复治疗的优缺点,以最佳证据为指导,选出最佳方案应用于临床实践。以人为本,做出科学决策,从而降低医疗费用及提高疗效及患者生活质量。     

研究生临床技能测试制度与临床决策能力培养

医学研究生的生源不同、学制不同和培养方式等的差异,导致医学研究生毕业时的临床技能和临床决策能力参差不齐。建立医学毕业研究生临床技能测试制度,合理地评价医学研究生毕业时的实际临床能力,从而制定针对个体的临床技能培养方案,为快速培养和提高青年研究生的临床决策能力提供有力的措施。     

Identifying thriving Workplaces in Hospitals: Work Characteristics and the Applicability of Character Strengths at Work

In most of their work settings, the health and well-being of hospital physicians are at risk. Trends of work intensification and changing laws in the European Union and beyond have heightened the call for taking a closer look at the workplace and training conditions of hospital physicians. This study aims to identify specific work characteristics (such as autonomy, social support, cognitive demands, and skill adequacy), in order to determine conditions for the applicability of individual character strengths at work and in turn for increased work engagement and well-being. We examined our hypotheses based on cross-sectional (N = 173) and longitudinal self-report data (N = 72) of hospital physicians in Austria. The results identified significant indirect effects of skill adequacy, cognitive demands, autonomy, and social support at work – via the applicability of individual character strengths at work – on work engagement and general well-being. Longitudinal analyses additionally confirmed autonomy as a thriving work characteristic for promoting the applicability of individual character strengths over time (time lag: 6 months). This study revealed the value of enabling and preserving the applicability of character strengths in a hospital work setting and focused – for the first time – on its predicting work characteristics. Furthermore, it emphasizes the importance of securing skill adequacy early in the training of young physicians and encouraging, as well as, sustaining autonomy in their daily work life.

     

洞察力与医师临床工作能力

洞察力包括选择性编码、选择性比较、选择性联合。洞察力对于临床医师提高临床工作能力十分重要,可使医师更快速、更早、更准确地发现问题并做出积极处理。从生活中有意识的培养、临床工作中不断的有意识磨练、长期的临床积累以及强化基础理论学习、拓宽知识面都可提高洞察力,进而提高临床工作能力。     

Observations of Muslim Physicians Regarding the Influence of Religion on Health and Their Clinical Approach

Although most patients report wanting their physicians to address the religious aspects of their lives, most physicians do not initiate questions concerning religion with their patients. Although religion plays a major role in every aspect of the life of a Muslim, most of the data on the role of religion in health have been conducted in populations that are predominantly non-Muslim. The objectives of this study were to assess Muslim physicians' beliefs and behaviours regarding religious discussions in clinical practice and to understand the factors that facilitate or impede discussion of religion in clinical settings. The study is based on a cross-sectional survey. Muslim physicians working in a tertiary care hospital in Saudi Arabia were invited to complete a questionnaire that included demographic data; intrinsic level of religiosity; beliefs about the impact of religion on health; and observations, attitudes, behaviours, and barriers to attending to patients' religious needs. Out of 225 physicians, 91% agreed that religion had a positive influence on health, but 62.2% thought that religion could lead to the refusal of medically indicated therapy. Over half of the physicians queried never asked about religious issues. Family physicians were more likely to initiate religious discussions, and physicians with high intrinsic religiosity were more likely to share their own religious views. Residents and staff physicians tended to avoid such discussions. The study results highlight the fact that many physicians do not address patients' religious issues and that there is a need to clarify ethically sound means by which to address such needs in Islamic countries. Medical institutions should work to improve the capacity of medical personnel to appropriately address religious issues. The training of clinical religious advisors is a promising solution to this dilemma.