慢性硬膜下血肿患者临床路径实施效果分析

临床路径是确保医疗质量、控制医疗成本和优化医疗服务流程的管理工具.本文通过对实施临床路径前后的各项管理指标进行对比分析,探讨临床路径在慢性硬膜下血肿患者中的应用成效.研究表明通过实施临床路径,缩短了住院时间,降低了住院费用,提高了患者满意度,提高了医疗资源的有效利用率,降低了医疗资源消耗,有利于促进医院质量管理持续改进.     

临床路径在慢性硬膜下血肿患者的效果分析

探讨临床路径在慢性硬膜下血肿钻孔引流术患者中应用的可行性和效果评价.将66例慢性硬膜下血肿钻孔引流术患者随机分为实验组和对照组,每组各33例.实验组按制订好的临床路径表实施每日的主要诊疗工作、重点医嘱、主要护理工作、病情变化记录;对照组采用传统医疗护理方法.结果实验组患者的平均住院时间、平均术前时间、平均住院费用、平均药费明显低于对照组,患者满意度明显高于对照组(P＜0.01).病种临床路径可以规范医疗行为,提高医疗执行效率,降低医疗成本,提高医疗质量,提高患者及家属参与治疗过程的主动性,提高患者满意度,缓和医患关系.     

论临终者关系生命中的死亡价值建构

通过阐述当今中国死亡价值日渐消解所致苦难,指明死亡价值建构的重要性,挖掘中华传统生死观的底蕴,探讨死亡价值建构的可行性;将关系生命理念引入安宁疗护领域,将其与中华传统生死观对话,总结具有中华文化特色的临终者关系生命向度,并分析关系生命对于临终者死亡价值建构的意义;基于此,聚焦安宁疗护领域,探讨如何通过维护临终者关系生命来帮助其建构死亡价值,以期为构筑和发展具有中华文化特色的安宁疗护照护体系贡献理论和实践智慧。

     

On the Very Idea of Continental (or for that Matter Anglo–American) Philosophy

For most of the past century, philosophers on the Continent and those in the United States and Britain have taken themselves to be working in very different, even mutually exclusive, philosophical traditions. Although that may have been true until recently, it is no longer so. This piece surveys ten different proposed distinctions that have been offered between the two traditions, and it shows that none of them works, as there are major thinkers on both sides of each proposed distinction that do not neatly fit the proposal. The upshot of this is that it no longer makes sense to uphold the idea of two traditions, and that it is time we all dropped the mutual suspicion and denigration that have characterized relationships between us for the past hundred years.     

Two faces of Thanatos: Broken flowers (2005) and Ai no corrida (1976)1

Since Freud formulated the death instinct concept, it has received widely diverse interpretations. Even Freud advanced two versions. The concomitant analyses of two films, Ai no corrida (1976) [ In the realm of the senses (1977)] and Broken flowers (2005) evince Thanatos's two faces: the cold death of decathexis of an object, in the case of Don (in Broken flowers) and the hot death of the subject‐object fusion in Sada's case ( Ai no corrida). In our analysis, we elaborate two possible vicissitudes of the death instinct: in Broken flowers, the main character finds an ‘analyst’ and is cured. In Ai no corrida, the protagonist meets a complementary object and goes mad.     

ICU医务人员在心脏死亡器官捐献中面临的伦理问题及对策

心脏死亡器官捐献是目前解决器官移植工作器官短缺的关键性举措,参与器官捐献过程的ICU的医务人员需要直接面临对潜在捐献者的治疗照护、临终护理、死亡判定等诸多伦理问题.应加强ICU医务人员器官捐献伦理知识的普及教育并完善相关法律制度,以保证器官捐献工作的健康、可持续发展.     

传统生死孝道观与老年临终关怀

为了解决临终关怀发展的尴尬处境, 诸如临终关怀机构困境、“供给-需求”冲突、意义世界的冲突等问题, 以及传统生死观和孝道观影响下的老年临终关怀问题和生死孝道教育问题, 必须深入反思传统生死观和孝道观。因此, 试图通过生命教育、伦理环境改善、养老模式变革等方式, 树立新的生死观和孝道观, 以推进老年临终关怀发展, 从而提高老年患者生活质量、生命质量和生命尊严;并结合比较方法、价值分析方法对传统生死观、孝道观与老年临终关怀进行研究。     

生命回顾疗法介入晚期癌症患者死亡恐惧的实践探索

聚焦晚期癌症患者死亡恐惧,分析比较生命回顾疗法的实际应用。基于临床服务案例,医务社工发现晚期癌症患者的死亡恐惧主要受躯体症状、疾病归因、家庭支持和心性支持四方面影响。医务社工通过运用生命回顾疗法对晚期癌症患者进行干预,依托建立早期良好专业关系、正视死亡恐惧、回顾重要生命事件、强化/修复重要关系、增强自我认同五大策略,赋予患者生命新的价值和希望,实现生命意义的整合,有效缓解个体死亡恐惧,改善末期生命质量。

     

ICU生命末期患者死亡质量量表的汉化及信效度评价

为了翻译并修订重症监护病房生命末期患者死亡质量量表(QODD-3.2A),形成中文版QODD-3.2A,并对其进行信效度检验,先采用Brislin翻译模式对QODD-3.2A进行翻译、回译、专家咨询、预调查后形成中文版QODD-3.2A,之后采用便利抽样方法,对湖北省两所综合医院182例死亡患者的死亡质量进行调查并评价其信效度。通过分析,中文版QODD-3.2A量表有6个维度,共24个条目,累计方差贡献率为67.47%,总量表的Cronbach'sα值为0.891,折半系数为0.801,量表水平的内容效度指数为0.94。中文版QODD-3.2A具有较好的信效度,可作为国内ICU生命末期患者死亡质量的评估工具。     

Critical Notice of Beyond the Analytic-Continental Divide: Pluralist Philosophy in the Twenty-First Century. Edited by Jeffrey A. Bell,Andrew Cutrofello,and Paul M. Livingston (New York: Routledge, 2016. 334 + viii pp)

This collection maintains a dialogue between the analytic and continental traditions, while aspiring to situate itself beyond the analytic-continental divide. It divides into four parts, (1) Methodologies, (2) Truth and Meaning, (3) Metaphysics and Ontology, and (4) Values, Personhood and Agency, though there is considerable overlap among the categories. History and temporality are recurrent themes, but there is a lot of metaphysics generally, with some philosophy of language, philosophy of social science, ethics, political philosophy and epistemology. Less prominent is a pragmatic, deflationary attitude, and at a number of points I argue for the virtues of such an approach.     

35岁～64岁糖尿病患者1O年内心肌梗死＼中风发病和死亡危险评估

应用《未来10年内心肌梗死、中风发病和死亡危险的科学预测量表》,对某社区335例35岁～64岁糖尿病患者进行了评估。结果显示,35岁～64岁糖尿病人群未来10年内严重心血管事件发生风险甚高,对可逆危险因素的评估和调整刻不容缓。