生存论向度的技术伦理前提及其建构

技术伦理涉及价值观基础、道德规范、技术主体的责任等诸多问题.无论是传统的元伦理学、情感主义伦理学、规范伦理学还是所谓的实用伦理学,都只是从某一个维度上或在某一个层面上来阐述伦理问题,从而在一定程度上表现为对于人的生存价值的背离和对发展合理性的伦理诉求的缺失,这样就使技术伦理研究本身在某种程度上失去了应有的合理性.在合理性上,技术伦理研究不能脱离开对技术本质属性的认识和基本的理论前提.从生存论的向度审视,生存价值才是伦理的内在价值基础,而发展的合理性才是技术伦理建构的基本逻辑支点.只有在此基础上,技术伦理才能实现合理的建构.     

肿瘤外科随访项目的策略探索

随访是目前肿瘤综合治疗的一个不可或缺的组成部分,尤其在肿瘤外科。为了提高恶性肿瘤的整体生存疗效、改善术后生活质量、提供高质量的,临床证据,应高度重视肿瘤外科术后随访工作,使参与随访成为肿瘤外科的一种积极的“诊疗文化”。我们的经验是在一个研究单位或地区组织一个针对某一患者群体进行随访的项目组实体,在校医学生作为志愿者早期参与到某些临床研究随访中。我们强调重视数据库建设、随访宣教、多平台立体式的随访方法和详尽的随访内容,以及加强质量控制。如何进一步提高随访效率和质量,以及如何完善长期运行随访项目组的机制,都需要我们在今后不断探索、交叉学习和总结经验。     

慢性肾脏病患者心理状态研究进展

慢性肾脏病是一种很难治愈的一种疾病,绝大多数的患者需要中西医结合治疗。患有慢性肾脏病的患者最终需要肾脏替代疗法来缓解症状,如透析治疗或选择肾脏移植。巨大花费同疾病本身使患者身心均受到很大的压力,CKD患者抑郁、焦虑情况普遍存在,影响患者生存质量、营养状态和治疗配合性及疾病的预后,因此解决其心理问题至关重要。     

肿瘤病人生活质量的临床量表评定

肿瘤临床生活质量评定的组合模式,包括两个基本原则：“核心”问卷用于不受癌症种类限制的癌症病人,便于不同研究之间进行比较;诊断特异和／或治疗特异问卷作为核心问卷的附加问卷用于某一种癌症和／或某一种治疗的癌病人,满足临床特殊问题的研究和运用。在组合模式指导下编制的生活质量核心问卷和肺癌附加问卷已成熟地运用于肿瘤临床。     

高通量血液透析对老年患者并发症的临床观察

研究高通量血液透析对老年透析患者常见并发症治疗的疗效.通过前瞻性试验研究,试验组为18例老年透析患者采用高通量血液透析,对照组为28例老年透析患者采用常规维持性血液透析.试验1年后分别测定顽固性高血压、症状性低血压、肌痉挛、心律失常、心绞痛及皮肤搔痒的发生率.结果试验组透析患者并发症明显缓解,对照组发生率明显上升(P＜0.05).因此,高通量血液透析可以明显降低透析相关并发症的发生,改善患者生活质量和生存质量.     

癌症患者生存质量研究进展

随着癌症患者生存时间和生存人数的增加,生存者本人和家属更加重视生存质量。本文总结分析近年来国内外癌症患者生存质量的研究状况,以期在癌症治疗过程中,不仅关注躯体功能和疾病本身以及由治疗带来的症状和体征,同时注重心理和社会职能。     

晚期乳腺癌外科治疗的时机与个体化选择

IV期乳腺癌是难以治愈的疾病,治疗方法是综合治疗,目的是缓解症状、改善生活质量、延长生存期。外科治疗作为综合治疗的一部分,对手术切除Ⅳ期乳腺癌原发灶或转移灶的临床意义和手术时机存在争议,本文结合文献从哲学的角度分析讨论Ⅳ期乳腺癌是否需要外科处理。认为Ⅳ期乳腺癌全身治疗和外科治疗是治疗过程中矛盾主要方面和次要方面的关系,可互相转化,两者作用相辅相成,当全身治疗病情缓解时,个体化选择外科治疗不仅改善生存质量,还可能提高生存率。     

生存质量在晚期肿瘤疗效评价中的思考

传统的肿瘤疗效评价方法多采用治愈率、生存率等指标来衡量。随着传统医学模式向生物一心理一社会医学模式转变,生存质量越来越受到重视。生存质量从一个新的角度评价治疗效果,更重视患者的主观感受,而不是仅将临床客观指标作为评价标准,能更客观地指导治疗方案的选择。     

肿瘤病人生活质量的临床量表评定

肿瘤临床生活质量评定的组合模式,包括两个基本原则“核心”问卷用于不受癌症种类限制的癌症病人,便于不同研究之间进行比较诊断特异和／或治疗特异问卷作为核心问卷的附加问卷,用于某一种癌症和／或某一种治疗的癌症病人,满足临床特殊问题的研究和运用。在组合模式指导下编制的生活质量核心问卷(QLQ-C30)和肺癌附加问卷(QLQ-LC13)已成熟地运用于肿瘤临床。     

微创与开腹手术治疗胆管结石患者生存质量的比较

采用消化病生存质量指数（gastrointestinal quality of life index,GIQLI）前瞻性测定45例微创内引流一期缝合术与42例开腹胆总管探查术治疗肝外胆管结石在术前、术后2,4,8,12周的生存质量值。结果显示微创组较开腹组治疗肝外胆管结石更有利于患者术后恢复和生存质量提高,微创手术患者术后生存质量更好。     

An Integrated Conceptual Model of Quality of Life for Older Adults Based on a Synthesis of the Literature

Quality of life is fast becoming a standard of measure of long-term care and gerontological service outcomes. Although the issue of quality of life has been of increasing interest in the field of aging, there has been little agreement as to the clarity and definition of the concept and how to measure it, especially as it relates to older adults. Presented here is a comprehensive, integrated model of quality of life that was developed by synthesizing existing constructs within the literature into six major life domains—(1) social well-being, (2) physical well-being, (3) psychological well-being, (4) cognitive well-being, (5) spiritual well-being, and (6) environmental well-being. Consistent with a general systems framework, this holistic model expands the predominant Health-Related Quality of Life constructs to incorporate non-physical aspects of well-being. Each of these domains was broken down into several dimensions in an effort to operationalize the concept of quality of life so that it can have some common standard of useful measurement. These major life domains and indicators are important factors in determining the perceptions of quality of life of older adults. Understanding what constitutes quality of life and how to measure it comprehensively has significant implications for social policy and practice in the field of aging.     

Antihypertensive treatment,compliance, and quality of life: Review of a little-understood relation

If patients notoriously violate treatment regimens known to effectively control hypertension, then there must be some subjective costs associated with adherence to these regimens. Generally speaking, there must be some reduction in quality of life associated with antihypertensive medication. Unfortunately the concept of quality of life, due to its lack of specificity, is of little help in further investigating the nature of these subjective costs. We developed a simple neuropsychophysiological model based on fundamental psychological and physiological processes: corticoinhibitory effects of phasic blood pressure elevation reduce the aversive or painful qualities of many stressors. This negative reinforcement increases the rate of the reinforced physiological behavior, i.e., phasic analgesic blood pressure increases. Such negatively reinforced operant behavior is known to be extremely resistant to extinction. Counter actions such as taking antihypertensive medication not only lead to reduced quality of life due to their cancellation of the analgesic effect of conditioned blood pressure increase, but also lead to some form of reluctance to comply with treatment. The model not only provides an innovative etiological path to the emergence of neurogenic essential hypertension, but also yields a highly specific and lean concept of quality of life. Furthermore, it supplies the health care community with a concise explanation for the well-known low compliance of patients with their antihypertensive regimens. In addition to its parsimony, the model fits well with various experimental findings and has been operationalized and tested empirically. Specific therapeutic implications can be derived.     

Mentalisierungsbasierte Psychotherapie bei schizophrenen Psychosen

Recently, there has been growing interest in new methods of psychotherapeutic interventions for schizophrenic patients. Social cognition, social functioning and quality of life are central objectives. Mentalization-based therapy (MBT) is a specific psychodynamic method developed from the fundament of attachment theory and empirical psychotherapy research for the treatment of borderline personality disorder, particularly focusing on attachment relationships, mentalizing capacity and affect regulation. Studies have shown that MBT is able to ameliorate interpersonal experience and social life. The latest neuroscientific findings support this view and encourage the application of a modified form of MBT in the treatment of schizophrenic patients. The authors present a concept for disorder-specific interventions in schizophrenia, including psychoeducational aspects and mentalizing exercises which step-by-step lead to a more reflective work in mentalization-based group psychotherapy.     

the promise of quality of life

Little has been written in the career development literature about quality of life, even though this concept is implied in all counselor interventions. In this article, the author suggests that the broad and subjective nature of quality of life, rather than a liability, is its very strength. Quality of life is presented as an important holistic concept that emphasizes a multidimensional awareness of the web of relationships within which career development is performed. The practical implications of quality of life for career development are discussed.     

Global Progress II: Evolutionary Mechanisms and their Side-effects

This paper attempts to update the 18th century concept of progress by an evolutionary theoretical framework, while replying to some of the contemporary critiques. Progress, understood as increase in fitness (or its proxy, quality of life) necessarily accompanies evolution by natural selection. In socio-cultural evolution, this mechanism is reinforced by growth of knowledge and virtuous cycles, but can be accompanied by negative side-effects such as overshooting and parasitism. The most pressing of the contemporary side-effects, such as pollution and the increased pace of life, are discussed, but it is concluded that they can be tackled without really endangering global progress. The anxiety that they engender is unfortunately amplified by a bad news bias in the media, leading to an inappropriately pessimistic view of the situation by the public.     

Belief and believing

Conclusion This essay has been somewhat programmatic in quality but that is not accidental. It has tried to identify some elements, historical and philosophical, that might provide a context within which an adequate discussion of the concept of belief and its recent diverse employment might be measured. Not very much has been solved, but perhaps some issues have become clearer.     

姑息治疗及其在肿瘤学中的地位

本文对姑息治疗的历史及概念作了详细的介绍,解释了其不同阶段的内涵,作为医学学科之一,姑息治疗的内容主要包括了疾病伴随或治疗所致症状的诊断评估、预防和治疗,心理和非癌性躯体疾病的预防和治疗,姑息治疗的科研、教学和教育以及终末期病人的治疗和护理等,特别纠正了对“安乐死”的看法。在肿瘤学中,经过40多年,它已从治疗中的辅助角色迅速成为肿瘤综合治疗中的主角,且贯穿于始终。它倡导多学科协作,与抗癌治疗完整结合,对无法治愈的晚期癌症患者以缓解症状、改善生活质量为主要目标,在全球范围内,很大一部分晚期肿瘤病人已从姑息治疗中明显获益。它的有力实施,也是我们创建和谐社会的重要反映。     

心理科学的生命力在于超越与容纳

科学心理学19世纪末传入中国。在中国经历了几十年的坎坷历程,直到1978年后,才得到正常的发展。改革开放20年来,心理学参与了国家的发展和建设,也强化了自身,取得了举世瞩目的成绩。但是,心理科学工作者必须超越自己原有知识的局限性,容纳一切自己没有学习过的东西;必须超越自己的视野,走出实验室,走出校门,面向社会,容纳一切个人不熟悉的东西;还必须超越本地区、超越国界,容纳先进地区、发达国家的先进经验,才能使我们的心理科学具有强大的生命力,才能推动心理科学的空前发展。     

Sleep and Sleep Disorders in Older Adults

A common but significant change associated with aging is a profound disruption to the daily sleep-wake cycle. It has been estimated that as many as 50% of older adults complain about difficulty initiating or maintaining sleep. Poor sleep results in increased risk of significant morbidity and mortality. Moreover, in younger adults, compromised sleep has been shown to have a consistent effect on cognitive function, which may suggest that sleep problems contribute to the cognitive changes that accompany older age. The multifactorial nature of variables affecting sleep in old age cannot be overstated. Changes in sleep have been thought to reflect normal developmental processes, which can be further compromised by sleep disturbances secondary to medical or psychiatric diseases (e.g., chronic pain, dementia, depression), a primary sleep disorder that can itself be age-related (e.g., Sleep Disordered Breathing and Periodic Limb Movements During Sleep), or some combination of any of these factors. Given that changes in sleep quality and quantity in later life have implications for quality of life and level of functioning, it is imperative to distinguish the normal age-related sleep changes from those originating from pathological processes.     

科学是中医的“紧箍咒”吗？——中医与科学相关问题的思考

中医的科学属性近年来备受争论,从辩证哲学、科学观念、中医的人文哲学特色等角度剖析中医的哲学内涵和科学隶属,澄清观念,得出结论,中医本身就是一门人文与科学交融的古代科学,传统文化与现代科技的互融互动,合而不同,新世纪发展中医的认识观需要与时俱进。