外科医生面临的困惑和思考

外科医生面临越来越大的压力和严峻的挑战,由于外科技术的局限性和人体差异的复杂性以及社会诉求价值过高等因素决定了外科是一门高风险的职业。如何规避职业风险?我们可以从加强责任心、严格执行医疗常规、提高医疗技术入手;但这还不够,一个外科医生智慧与技能的发掘以及处理问题的能力与技巧,还需要良好的职业素养、崇高的职业精神、科学的思维方法、和睦的医患关系。     

神经外科高新技术应用中的人文问题

本文在分析医疗高新技术给神经外科带来发展的同时,阐述了其所带来的一系列人文问题。并对神经外科医务人员如何在临床中合理应用医疗高新技术,把握好医患关系,合理利用医疗资源,表现良好的医德医风提出了要求。     

Germ-line gene therapy and the clinical ethos of medical genetics

Although the ability to perform gene therapy in human germ-line cells is still hypothetical, the rate of progress in molecular and cell biology suggests that it will only be a matter of time before reliable clinical techniques will be within reach. Three sets of arguments are commonly advanced against developing those techniques, respectively pointing to the clinical risks, social dangers and better alternatives. In this paper we analyze those arguments from the perspective of the client-centered ethos that traditionally governs practice in medical genetics. This perspective clarifies the merits of these arguments for geneticists, and suggests useful new directions for the professional discussion of germ-line gene therapy. It suggests, for example, that the much discussed prospect of germ-line therapy in human pre-embryos may always be more problematic for medical genetics than adult germ-line interventions, even though the latter faces greater technical difficulties.     

ADR解决中国医患纠纷的可行性分析:医患双方的调查

目前我国医患关系紧张,医患纠纷解决机制是行政和司法为主的机制。有无更科学、合理、有效的解决办法。通过调查和理论分析,认为ADR应该成为我国解决医患纠纷的主要机制。协商是医生和患者最愿意采取的方式,仲裁和调解也是可行的,应该是我国医疗事故处理的有效补充。     

Sciences médicales et droit

How does Law unravel and seize Medicine? The relationship between Law and Medicine is tremendously complex. At first sight, Law understands medicine as being a medical science, an applied science, and imposes requirements in this regard, such as respect for the “established scientific knowledge” or “tested medical knowledge”. But Medicine turns out to be “Art”, a clear and authentic expertise which requires techniques reiteration. Seen by Law, Medicine is not classified into either both of these scientific or technical dimensions. Borrowing from human sciences also allows to set requirements for medical humanism.     

食管癌早期诊断方法的哲学思考

食管癌早期诊断方法和技术,涵盖了医学科学、放射技术、光学及电子技术、计算机技术等相关高新技术学科。回顾食管癌早期诊断方法和技术的历史发展,不难看出,临床需求是引发技术创新的原动力,多学科交叉合作研究是加速新技术研制和推广的前题,新技术的开发应用必须以临床和基础研究为基础。科学技术进步推动了医学发展,早期诊断方法和技术的不断发展和进步对降低食管癌发病率和死亡率起着重要作用。     

Third party assisted conception: an African perspective

The central importance of reproduction in all human cultures has given rise to many methods and techniques of assisting reproduction or overcoming infertility. Such methods and techniques have achieved spectacular successes in the Western world, where processes like in vitro fertilization (IVF) constitute a remarkable breakthrough. In this paper, the author attempts to reflect critically on assisted reproduction technologies (ART) from the background and perspective of African culture, a culture within which human reproduction is given the highest priority but which also exhibits a highly ambivalent attitude to modern technology-assisted methods of reproduction. The author considers the ethical crux of reproductive technologies to be linked to the issue of the moral status of the human embryo and argues that a morally significant line of demarcation cannot be drawn between embryos and other categories of humans.     

FNDSB: A fuzzy-neuro decision support system for back pain diagnosis

Back pain is a common pain felt in the back. In the world, it is the fifth common reason for physician visits and in the U.S. about 90% of human adults have back pain at some time in their life. In this paper, we proposed a decision support system for intelligent diagnosis of back pain using a fuzzy-neuro technique to manage the fuzzy concepts. It is also provide an intelligent decision support platform that can assist physicians to diagnose and produce accurate medical advices. The proposed system consists of a user interface that receive symptoms and produce accurate diagnosis with its severity, a fuzzy inference system which contains the strategies of reasoning process based on fuzzification and defuzzification techniques, a fuzzy-neuro system that composed of neural network with fuzzy logic concepts, and a knowledge base which collects of linguistic fuzzy rules. The FNDSB describe knowledge acquisition and representation methods, a way of production linguistic fuzzy rules organization, fuzzification and defuzzification of clinical parameters as input and output values using a Triangular Membership Function (TMF) and Centroid of Area (CoA) techniques respectively. The FNDSB was evaluated using a case study of 10 patients from Al-diwaniyah teaching hospital. According to the evaluation results the system performance around 83.6% efficiency in producing accurate back pain diagnosis.     

Possibilities and limits of mind-reading: A neurophilosophical perspective

Access to other minds once presupposed other individuals’ expressions and narrations. Today, several methods have been developed which can measure brain states relevant for assessments of mental states without 1st person overt external behavior or speech. Functional magnetic resonance imaging and trace conditioning are used clinically to identify patterns of activity in the brain that suggest the presence of consciousness in people suffering from severe consciousness disorders and methods to communicate cerebrally with patients who are motorically unable to communicate. The techniques are also used non-clinically to access subjective awareness in adults and infants. In this article we inspect technical and theoretical limits on brain–machine interface access to other minds. We argue that these techniques hold promises of important medical breakthroughs, open up new vistas of communication, and of understanding the infant mind. Yet they also give rise to ethical concerns, notably misuse as a consequence of hypes and misinterpretations.     

Tragic figures: Thoughts on the visual arts and anatomy

The illustrated anatomical works of Andreas Vesalius, now icons of medical history, exemplified Renaissance humanists' attitudes toward the human condition. Methods of teaching medical students gross anatomy have evolved from the attitudes and methods of Renaissance scientist-scholars. The work of Vesalius is crucial to understanding the revolution in early modern medicine, for not only is it devoted to minute observation and exploration of the human body, but also to translating new knowledge by means of art. In the process of illustration, the cadavers become ennobled, leading the viewer to contemplation of the nature of our common humanity. It is the thesis of this paper that the merging of art and science achieved in the great anatomical studies of the 16th and 17th centuries may still be useful in the education of medical students by allowing a balance between scientific detachment and compassion.     

微创医学--一个新的医学理论体系

在新的世纪里,为了回归医学本源、适应人类社会发展的需要,有必要探求一种新的医学智慧、建立一个新的医学系统.从历史唯物主义和辩证法的现点出发,在深入研究"微创"概念及内涵的发展演变、二十一世纪医学发展的未来趋势和社会对医学-医院最大要求的基础上,作者等以生物心理社会医学模式为基础,在学界提出了"微创医学"的概念、建立了"微创医学体系"并正在进行着微创医学的具体实践--在微创医学理论指导下建设"微创医院".本文详细描述了微创医学体系:基本理论系统和临床架构系统.创立微创医学体系的根本目的在于在医学上、在医院里达到真正实现"以人为本"的理念.     

“Nanostandardization” in Action: Implementing Standardization Processes in a Multidisciplinary Nanoparticle-Based Research and Development Project

Nanomaterials have attracted much interest in the medical field and related applications as their distinct properties in the nanorange enable new and improved diagnosis and therapies. Owing to these properties and their potential interactions with the human body and the environment, the impact of nanomaterials on humans and their potential toxicity have been regarded a very significant issue. Consequently, nanomaterials are the subject of a wide range of cutting-edge research efforts in the medical and related fields to thoroughly probe their potential beneficial utilizations and their more negative effects. We posit that the lack of standardization in the field is a serious shortcoming as it has led to the establishment of methods and results that do not ensure sufficient consistency and thus in our view can possibly result in research outputs that are not as robust as they should be. The main aim of this article is to present how NanoDiaRA, a large FP7 European multidisciplinary project that seeks to investigate and develop nanotechnology-based diagnostic systems, has developed and implemented robust, standardized methods to support research practices involving the engineering and manipulation of nanomaterials. First, to contextualize this research, an overview of the measures defined by different regulatory bodies concerning nanosafety is presented. Although these authorities have been very active in the past several years, many questions remain unanswered in our view. Second, a number of national and international projects that attempted to ensure more reliable exchanges of methods and results are discussed. However, the frequent lack of publication of procedures and protocols in research can often be a hindrance for sharing those good practices. Subsequently, the efforts made through NanoDiaRA to introduce standardized methods and techniques to support the development and utilization of nanomaterials are discussed in depth. A series of semi-structured interviews were conducted with the partners of this project, and the interviews were analyzed thematically to highlight the determined efforts of the researchers to standardize their methods. Finally, some recommendations are made toward the setting up of well-defined methods to support the high-quality work of collaborative nanoparticle-based research and development projects and to enhance standardization processes.     

新医学模式在慢性前列腺炎临床中的应用

现代医学对慢性前列腺炎的认识已经经历了近200年,其发病机制、诊断和治疗等多方面存在很多疑惑和争议。慢性前列腺炎不能单纯视为躯体性疾病,其发生、发展和转归与精神心理和社会因素密切相关。新医学模式(生物-心理-社会医学模式)发展和医疗实践有机结合,将促进泌尿外科医师和患者对慢性前列腺炎疾病更深刻认识,这不仅为提高慢性前列腺炎诊断提供了新的视角、指标和工具,也为有效治疗提供了新的思路、技术和方法,为全面提高患者的生活质量提供了可能。     

Maximum-likelihood estimation of the accuracy of auditory discrimination in the absence of an overt response to every stimulus

In research on human performance in which techniques for estimating hits and false-alarm rates are used in conjunction with other measurements, such as evoked potentials, it is necessary to devise special data-collection methods. This paper describes such data-collection methods, together with a statistical method for summarizing the data. The statistical method consists of setting up a probability model whose parameters describe the process and then estimating the parameters using maximum likelihood.     

The labours of Hercules: some good reasons why social workers should not try to be different, and practice family therapy

Family therapy, despite being an approach to problems in a social context, has, for the most part, been developed and refined in medical settings (Adams, 1979). Family therapy propounds a methodology based on social rather than medical techniques of intervention. It is logical to suggest that workers based in socially-orientated agencies, rather than medical settings, could be predicted to be better placed to utilize and develop this particular approach to human problems. How can it be explained that the main bulk of the innovations are still coming from practitioners who have trained primarily in medical approaches and settings? This article looks at some of the reasons why family therapy practice and development is not flourishing in Social Services Departments as it is in, for example, hospitals and clinics. The authors do not offer any positive conclusions at this stage, but will show, in a later publication, what has been achieved in some Social Services Departments, and how practice has been established despite the organizational and operational constraints implicit in the introduction of a family, or systems orientated method, to an agency traditionally and statutorily focused upon the individual.     

呼唤人性的医学——对医学人性化和人文化回归的企盼

当前 ,在医学领域尤其是临床医疗领域存在着严重的“人性淡漠”趋势 ,这一现象令人十分担忧 ,它不仅将严重阻碍医学自身的健康发展 ,而且会产生恶劣的社会影响。列举了当今医界带有普遍性的“人文精神贫乏症”的种种表现 ,在此基础上 ,深入剖析了这一现象背后的历史与现实、社会与个人的诸多原因。最后发出了“人性医学回归”的强烈呼唤 ,并提出了一些具体的且有现实意义的对策措施。     

认知神经科学领域脑电复杂性测度方法的新进展

脑电分析是认知神经科学研究领域重要的研究技术之一。本文主要介绍了新近发展的KC、C1、C2 、C0 、信息传输矩阵和近似熵等基于非线性动力学的脑电复杂性测度分析方法 ,对各种方法的特点进行了简单的讨论 ,并简述了其在分析认知电位时空模式 ,从而揭示脑认知功能研究中的应用。     

Measuring the quality of life: Why,how and what?

In this paper three questions concerning quality of life in medicine and health care are analysed and discussed: the motives for measuring the quality of life, the methods used in assessing it, and the definition of the concept. The purposes of the study are to find an ethically acceptable motive for measuring the quality of life; to identify the methodological advantages and disadvantages of the most prevalent current methods of measurement; and to present an approach towards measuring and defining the quality of life which evades the difficulties encountered and discussed. The analysis comprises measurements both in the clinical situation concerning individual patients and in research concerning whole populations. Three motives are found for evaluating the quality of human life: allocation of scarce medical resources, facilitating clinical decision making, and assisting patients towards autonomous decision making. It is argued that the third alternative is the only one which does not evoke ethical problems. As for the methods of evaluation, several prevalent alternatives are presented, ranging from scales of physical performance to more subtle psychological questionnaires. Clinical questionnaires are found to fail to provide a scientific foundation for universally measuring the quality of life. Finally, the question of definition is tackled. The classical distinction between need-based and want-based theories of human happiness is presented and discussed. The view is introduced and defended that neither of these approaches can be universally preferred to the other. The difficulty with the need approach is that it denies the subjective aspects of human life; whereas the problem of the want approach is that it tends to ignore some of the objective realities of the human existence. In conclusion, it is argued that the choice of methods as well as definitions should be left to the competent patients themselves — who are entitled, if they so wish, to surrender the judgement to the medical personnel. Technical factors as well as the requirements of respect for autonomy and informed consent support this conclusion.     

Catholic Reflections for an Updated Donum Vitae Instruction: A New Catholic Challenge in a Post-Christian Europe

On February 22, 1987, the Congregation for the Doctrine of theFaith published the Donum Vitae Instruction. Twenty years later,on February 22, 2007, Pope Benedict XVI asked for an updateof this Instruction. According to the Donum Vitae Instructionof 1987, the principle of the holiness of life imposes respectfor human persons from the very beginning of human life. Inthese past 20 years, new medical techniques have raised freshethical issues that are to be addressed by the Roman CatholicChurch Magisterium. The Roman Catholic Church, in its updateof the Instruction planned for 2007, will have to explain howcivil law is to be regulated according to the fundamental normsof the moral law. The moral message of the new Donum Vitae (justas in the 1987 version) will be to affirm the substance of humanjustice: respect for human life, as expressed in the resolvenot to infringe on, or to protect such life. Even in a post-ChristianEurope, this theological message can be understood if it istrue that Europe is marked by the principle of the absoluteprotection of human life.