男性不育症临床工作的问题与思考

在临床工作中,不育越来越受到大家的重视,但仍然有许多问题困扰着我们的医疗工作者,多数医生能对男性不育症做出诊断,并给予治疗.但是由于生殖问题的复杂性和我们认识的局限性,不育症的治疗效果并不满意.在不育症诊断和治疗的思路、方法和方式中仍有许多值得探讨和改进之处.     

关注幽门螺杆菌治疗中的实际问题

我国对Hp感染诊断和治疗有自己的标准,也有很多成熟的经验,但在根除HP治疗过程中,存在诸多问题,如过度医疗、适应证掌握不严格、第一次根除失败后再次治疗不规范等。我们应共同关注这些问题,提高Hp根除率,降低治疗中的副作用,对HP的许多未知问题从不认识到认识。     

关注幽门螺杆菌治疗中的实际问题

我国对Hp感染诊断和治疗有自己的标准,也有很多成熟的经验,但在根除HP治疗过程中,存在诸多问题,如过度医疗、适应证掌握不严格、第一次根除失败后再次治疗不规范等.我们应共同关注这些问题,提高Hp根除率,降低治疗中的副作用,对HP的许多未知问题从不认识到认识.     

不育症临床治疗中的人文关怀

随着不育症患者的不断增多,不育症治疗技术的迅速发展及医学模式的转化,在不育症临床诊疗中应树立人文关怀的理念,强化人性化服务的意识.在工作中应遵循患者第一的原则并恪守心身统一原则、保密原则、最优化原则、知情同意等原则.在治疗过程对患者同情、鼓励以及进行心理治疗,体现人文关怀,构建和谐的诊疗气氛.     

宫颈癌普查与人文关怀

随着不育症患者的不断增多,不育症治疗技术的迅速发展及医学模式的转化,在不育症临床诊疗中应树立人文关怀的理念,强化人性化服务的意识。在工作中应遵循患者第一的原则并恪守心身统一原则、保密原则、最优化原则、知情同意等原则。在治疗过程对患者同情、鼓励以及进行心理治疗,体现人文关怀,构建和谐的诊疗气氛。     

辅助生殖技术中的伦理问题

随着医学科技的不断发展 ,人类对不孕不育症的治疗方法也逐渐走向尖端 ,从人工授精、配子移植、体外受精—胚胎移植技术 (一代、二代和三代技术 )直到如今在伦理道德上颇有争议的克隆技术 ,这些技术对不孕症患者来说无疑是个福音 ,但其中一些技术也派生出许多伦理道德上的问题 ,孰是孰非 ,难以判定。本文就辅助生殖技术中的一些伦理问题加以探讨。人工授精是指用器械将精液注入宫颈管内或宫腔内取代性交使女性妊娠的方法。根据精液的来源可分为三类 :(1 )丈夫精液人工授精 (ＡＩＨ) ,适用于男方患性功能障碍 ,女方宫颈异常、抗精子阳性等患…     

男性不育患者的心理社会因素的研究

男性不育是一个较为复杂的临床综合症。婚后同居2年以上,有正常性生活,未采取避孕措施,女方不怀孕,称为不育症。在中国10对夫妇中约1对发生不育,属于女方因素约为60％,单属于男方约40％,属于男女双方共同的约10％。欧美等国家不育症患病率约为15％—20％。不育是令人非常痛苦的事,它不仅严重影响患者的身心健康,而且还会带来一定的社会问题。因此,不育症的相关因素显得颇为重要。本文对30列男性不育患者和30例已育子女的健康男性进行心理社会方面的调查研究。     

男性不育的情绪疗法

男性不育症的病因较为复杂,既有先天禀赋不足,又有后天功能障碍和病理改变。中医学对本病早有论述,并有效地指导着临床。西医对本病的诊治也日臻完善。本文从中医心理学的角度,谈以情胜情疗法在男性不育症中的临床应用,介绍几则成功案例以飨读者。     

功能性消化不良研究的哲学思考

消化不良的研究一直引起胃肠病家们的极大兴趣 ,其原因很清楚 :消化不良是一个常见的问题 ,在每位胃肠科医生的临床实践中 ,确实占有相当分量。对消化不良的诊断 ,适当的检查和处理远非易事 ,即使是参考了已有的全部检查材料 ,许多消化不良病人显然并未发现可导致其症状出现的疾病过程或病理学改变。许多医生在向这些病人解释检查结果 ,作出诊断和提出治疗方案时 ,也都“心犹未尽”。因此对功能性消化不良诊断进行哲学思考 ,选择合理、简便经济的诊断方法 ,有利于提高功能性消化不良诊断的诊断率并对消化不良的治疗做出临床指导。1　命名学…     

伦理,胚胎和干细胞研究

道德是关于规则、直觉、理解和观点的一个复杂系统。而后者影响着我们相互间处理事务的方式。它们交叉地渗入我们的道德思考。这种思维与胚胎、干细胞的伦理密切相关,因为胚胎和干细胞涉及我们对与治疗和移植组织有关的人的生命及其启始问题。就像在许多对待生命及其可以阐释的研究方法方面,要有一个道德的思辩历程一样,解决这些问题,部分地需要讨论,部分地需要回答。只有在我们认定这种讨论能够融入应用干细胞治疗的胚胎及其类源和人体组织的使用中时,我们才会清楚,大多数人体不同部位的干细胞应用是经过了对人的生命启始、我们儿童、家庭进行了思考。     

The psychological reactions to infertility: Sex roles and coping styles

The purpose of this study was to determine if sex roles would predict the extent to which people experience problems in coping with infertility. Based on questionnaire responses of 164 medical patients, it was found that patients scoring higher in masculinity or androgyny reported fewer problems in coping with infertility, as measured by self-esteem and body image. It was also found that groups of infertile, formerly infertile, and fertile patients were no different in levels of coping. It was suggested that physicians might be able to identify patients at risk for poorer coping with infertility by screening new referrals for self-esteem and historical-background variables.     

脑死亡判定的伦理学及实践中的几个问题

脑死亡是临床实践中的常见问题,随着当代医学科学的发展,经过临床严格的判定程序,患者脑死亡即生物学死亡已经成为科学标准,但由于我国在脑死亡立法、公众认知以及医生的各种心理考量,在我国开展脑死亡的判定还存在许多障碍。我们结合自己在判定患者脑死亡后的医患心理变化,以及存在的一些问题,期望引起更多的医学、法学和社会学家关注,使得临床医生对脑死亡的判定,顺应科学发展又能符合患者及其家属的最大利益。     

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.     

Psychoneuroimmunology and male infertility: A possible link between stress,coping and male immunological infertility

Abstract

This current study investigated a link between stress and coping with some male infertility problems via psychoneuroimmunological theories. The study was carried out on 77 males who came to a fertility clinic for sperm diagnosis. Appraisal and coping with stress reaction to negative life events and to infertility were related to non-sperm cells within the seminal plasma. Those men who had felt strained from external events and from problems of infertility, and had used emotional escape coping strategies, were more prone to have an immunosuppressed reaction, indicated by bacteria within their plasma. Those using task focused control strategies were more prone to have an immunostimulatory reaction, indicated by white blood cells, including in some cases, sperm destroying phagocytes suggesting a possible auto-immunity reaction. When the analyses were done separately on patients with known male fertility problems in comparison with those with unexplained infertility, the two opposing psychoneuroimmunological processes became more pronounced.     

The physician and social renewal: Julius B. Richmond as role model

We live in an age of “high tech” medicine which affects both health care recipients and physicians who are taught its many wonders and uses. It is easy in this atmosphere of specialization for clinicians, professors and medical students to become isolated and to ignore social issues which affect health care in its broadest sense. Individuals who are committed to the “common good” are the ones historically who have been effective change agents. It would be tragic simply to stand back and allow the cynical and greedy to dominate any profession which deals with the poor, the uninsured and the homeless. It is imperative for physicians to take a broad view of today's problems in health care delivery systems, for they can have an enormous impact on the kind of world our children will inherit. It is essential for physicians to become involved in social concerns, and in improving health care delivery, at all levels in their practice. Given their power and prestige, it is crucial for physicians and aspiring physicians to have positive role models. Dr. Julius B. Richmond provides an admirable example of a physician who cares about his profession, his patients and his nation. Through his research, his public service and his teaching, Dr. Richmond has demonstrated the difference a single individual can make in improving the quality of life for all Americans.     

Children’s Psychosocial Problems Presenting in a Family Medicine Practice

Primary care physicians have an important role in identifying, treating, and referring children with psychosocial problems. However, there is a limited literature describing whether and how family physicians address psychosocial problems and why parents may not discuss children’s problems with physicians. The current study examined how family physicians address psychosocial problems and reasons that parents do not discuss children’s psychosocial problems with physicians. Results indicated that there are a variety of reasons involving parents, their perceptions of physicians, and the number of psychosocial problems reported, that may lead to fewer discussions of psychosocial problems.     

An Infertility Primer for Family Therapists:

A seemingly "self-evident truth" in most people's lives is that one day they will have children. This universal, biopsychosocial assumption goes unchallenged until a couple faces infertility. Although the effects of such a challenge are profound, infertility is often treated as a nonevent — both within our society as a whole, and within the field of family therapy in particular. To assist clinicians who work with this numerically increasing population, and the many others who have been affected by their encounter with infertility in the past, this article discusses the biological/medical, psychological, and social factors that shape the experience of infertility in our society.     

Sex differences in the professional orientation of first-year medical students

This article, presenting the findings from a 1975 survey of first-year medical students in the state of North Carolina, explores the relationship between students' sex and professional orientations considered relevant to current health care problems. The professional orientations concern four problem areas: (1) physicians' relationships with patients, (2) political and economic change in the medical profession, (3) the treatment of women physicians and women patients, and (4) geographic and specialty mal-distribution of physicians. Substantial sex differences are found for some professional orientations. As hypothesized, women orient more highly than men to humanizing physician-patient relationships, political and economic change in medicine, the problems facing women physicians and patients, and expecting an inner-city practice. Implications of the findings for health care and medical education are discussed.This report is based on the author's doctoral dissertation, Boys and Girls in White: Professional Orientation of the Student Physician Department of Sociology, Duke University, 1976. The author would like to express appreciation to Jim House for his continued guidance and encouragement as dissertation advisor.     

人文关怀在消除IVF—ET患者心理压力中的作用

近年我国不少生殖医学中心在如何提高体外受精一胚胎移植（IVF—ET）治疗成功率问题上,都将注意力集中在临床用药的研究、控制性超促排卵方案的改进以及实验室条件的改善上,大多忽视IVF—ET患者心理方面的治疗。有研究表明：IVF—ET治疗的成功,不仅与患者自身的病理及生理状况有关,更与患者在治疗过程中产生的心理压力有关。因此,建议医护人员在给不孕症患者实施IVF-ET助孕治疗的全过程中,应给予患者更多人文关怀,这样不仅能够减少IVF—ET患者心理健康问题的发生,而且可以改善患者的身心状态和应对治疗能力,从而提高IVF—ET治疗成功率。     

An Infertility Primer for Family Therapists: II. Working with Couples Who Struggle with Infertility

The distress of infertility and its medical treatments are profound, and the effects reverberate in each partner, the couple dyad, and the couple's relationships with family, friends, and medical systems. Yet family therapists, like others in our society, are often uninformed or misinformed about the experience of infertility. While the legacies of infertility may be painful and enduring, they often remain unspoken, and hence may be overlooked in standard interviews. This article describes the experiences of couples struggling with infertility, most of whom have sought medical intervention, and it provides treatment interventions for guiding couples through this difficult and often uncharted terrain. Case vignettes derived from 2 years of this clinical research study are included.