适宜技术与诊疗最优化临床应用患者方面的影响因素

从诊疗中的认识论和辩证法的角度,通过实际案例分析医生及患者对选择适宜技术实现诊疗最优化的消极和积极的影响;阐述了患者自身的经济状况在很大程度上影响着适宜技术的应用;患者的心理因素和家人的态度在一定程度上也影响着适宜技术的应用及实现诊疗最优化.医生要提高自己的综合素质,患者要充分发挥自己的主观能动性,消除消极的影响,增强积极的影响,共同促进适宜技术的临床应用及实现诊疗最优化.     

口腔专业适宜技术与诊疗最优化

推行适宜技术和诊疗最优化的原则是避免过度医疗的有效途径。而在口腔专业中必须要体现其特殊性。口腔治疗的总体目标是健康、美观,这一目标有赖于患者的主观评价;患者在治疗中具有自主选择的权利,而医生提供专业上的支持和具体的执行。因此口腔科适宜技术的基本要求是:适合患者的自身条件和需求、符合医学专业诊疗原则的要求以及适合医生的个人技术水平。然而对于我国现阶段而言,适宜技术是一个宽泛且较低的标准,而口腔临床工作中应该以最优化的治疗作为实际追求的目标。     

口腔专业适宜技术与诊疗最优化

推行适宜技术和诊疗最优化的原则是避免过度医疗的有效途径.而在口腔专业中必须要体现其特殊性.口腔治疗的总体目标是健康、美观,这一目标有赖于患者的主观评价;患者在治疗中具有自主选择的权利,而医生提供专业上的支持和具体的执行.因此口腔科适宜技术的基本要求是:适合患者的自身条件和需求、符合医学专业诊疗原则的要求以及适合医生的个人技术水平.然而对于我国现阶段而言,适宜技术是一个宽泛且较低的标准,而口腔临床工作中应该以最优化的治疗作为实际追求的目标.     

适宜技术与诊疗最优化的可行性研究

在案例分析的基础上,作出了医生是临床诊疗中适宜技术的主要选择者的判断;论证了运用适宜技术实现诊疗最优化的可行性;认为适宜技术难以选择和实施的主要原因是利益关系、责任心不强和管理措施不到位;提出了必须着力培育适合于适宜技术生长的土壤的对策,即:实行政策引导与资金支持、进一步加大监管力度、营造良好的氛围、高度重视并加强医生道德素质的培养.     

白内障手术中的适宜技术与诊疗最优化

在临床工作中为避免过度医疗,普遍的原则是大力推行适宜技术、适度医疗,并努力实现诊疗的最优化。在我国现阶段,适宜技术是一个宽泛且较低的标准,白内障手术中的适宜技术并不能使患者获得最佳疗效,达不到最优化医疗的要求。相信随着我国医疗体制的健全,白内障患者可以享受到最优化医疗。     

白内障手术中的适宜技术与诊疗最优化

在临床工作中为避免过度医疗,普遍的原则是大力推行适宜技术、适度医疗,并努力实现诊疗的最优化.在我国现阶段,适宜技术是一个宽泛且较低的标准,白内障手术中的适宜技术并不能使患者获得最佳疗效,达不到最优化医疗的要求.相信随着我国医疗体制的健全,白内障患者可以享受到最优化医疗.     

关于肿瘤专科诊疗最优化与过度医疗

肿瘤专科诊疗最优化准则有狭义、广义之分,二者既有区别,更有联系.肿瘤专科诊疗的过度医疗的内容是动态发展的,在特定情况下有其积极意义.实现肿瘤专科诊疗最优化,避免过度医疗,要重视矛盾问题"底线"的研究,提供相对宽松的技术、学术、文化氛围;医者持续的、有计划的专业学习与培训是增强其主体性的保证和前提;要充分考虑"可承受性"原则;用新的医德价值观指导现实中的医学道德实践;积极发挥医院伦理委员在肿瘤专科诊疗决策中的作用;建立与利用医务人员诚信档案.     

医患沟通对医生刻板印象表达的影响

从沟通频次与刻板印象传递性质的关系入手,以住院患者和尚未成为住院患者的大学生为被试,采用系列再生范式,利用10条4人再生链,探讨了医患沟通频次对医生刻板印象表达的影响。结果显示,与医生沟通频次高的住院患者在再生链的第2个位置传递医生的积极信息高于消极信息,但是经过4人的传递,住院患者对医生刻板印象信息的传递在积极信息与消极信息没有差异。而与医生沟通频次低的大学生在再生链的后期表现出传递医生消极信息的倾向。该结果表明：沟通频次能够调节有关医生的消极刻板印象的传递—与医生沟通频次高的群体在传递医生的刻板印象信息时,在传递的早期具有积极的倾向性;但经过多人传递之后,在效价方面已经没有倾向性;与医生沟通频次低的群体倾向于传递医生刻板印象的消极信息。     

认知负荷理论在临床诊疗中的应用探讨

认知负荷理论是近年来迅速发展起来的用于解释认知资源分配的心理学理论。临床诊疗工作本质上是医生对患者的病情信息认知加工并进行决策的过程。医生的认知负荷情况决定着医生认知加工的效率,认知加工效率决定了医生的工作效率。提高医生的认知加工效率可以通过对诊疗任务分配的调整,使诊疗任务产生的内在认知负荷与医生所能承受的认知负荷相适应,减少外在认知负荷,增加相关认知负荷三个方面来实现,从而可以提高诊疗的质量和效率,引导医生认知资源的合理分配。     

五行针灸与叙事医学的相互启发

五行针灸的实践让叙事医学有了新的证据来证明收集病历首页之外的信息及明确患者心理、情感需求对于临床诊断是有价值的,也启发叙事医学要形成一套具有临床诊疗指导价值的患者分类方法。在这个方法的指导下,医生能够基于其所收集到的患者体验、需求信息及自己的心理感受作出患者的诊疗推荐。叙事医学对五行针灸的启发是,为了增加医生对患者情感与需求的识别能力,提高其主导五行诊断结论的准确度,医生可在与患者交流时,采用叙事医学的方法来识别隐藏在患者表述中的情感与需求。在门诊结束后,医生可通过撰写平行病历及参与平行病历诵读会的方法来提高自己识别患者情感、需求的能力。     

Reflective minds and open hearts: Cognitive style and personality predict religiosity and spiritual thinking in a community sample

We examined associations between two psychological constructs, analytic cognitive style and the personality facet ‘Openness to Experience’, and several dimensions of religiosity: religious affiliation, strength of faith and spiritual epistemology. In a relatively large (N = 1093), older community sample (M = 55.4 years), analytic cognitive style was associated with a lower probability of affiliating with a religious denomination and a higher probability of possessing strong religious faith. Overall, openness was also associated with a lack of religious affiliation but was positively related to possessing a spiritual epistemology. A path‐analytic model revealed that openness had a positive relationship to both faith and religious denomination that was mediated by spiritual epistemology, but negative direct relationships with religiosity after the meditational effects were taken into account. Taken together, these results extend previous findings on the effect of cognitive style on religiosity and provide a new perspective on the complex relationship between cognitive and personality factors and different dimensions of religiosity. Copyright © 2014 John Wiley & Sons, Ltd.     

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。     

Focus of attention,self-esteem,and the attribution of causality

An experiment was conducted to investigate how actors' attributions of causality are affected by their expectancy about the outcome of an action and their observation of the actual outcome while in a state of high or low objective self-awareness. In the presence or absence of a camera, subjects delivered therapeutic instructions which were expected to have a positive or a negative effect and which resulted in a positive or a negative effect on a supposedly phobic patient. Principal findings were that (1) attributions to self were greater under high objective self-awareness for positive relative to negative outcomes, (2) attributions to the patient were relatively great under high objective self-awareness when a positive outcome was expected but a negative outcome actually occurred. The results are discussed in terms of the joint role of focus of attention and self-esteem processes in the attribution of causality and in terms of their relationship to Duval and Wicklund's (1973) “focus of attention” attributional analysis.     

Roles of cognitive load and self-relevance during emotional information searching on decision-making

Older adults have been found to favor positive stimuli over negative stimuli; further, developing a negative preference may be a cognitively demanding process. In the present study, we focused on the joint effects task self-relevance and cognitive load have on older adults' emotional information preferences when performing decision-making. To examine this, we used multi-attribute decision tasks and process-tracing procedure to measure their searching process. The study composed of a 2 (age: young/old) × 2 (cognitive load: load/non-load) × 3 (attribute valence: positive/neutral/negative) × 3 (task self-relevance: high/medium/low) mixed design. Sixty-one young adults and 62 older adults viewed 5 (alternatives) × 5 (attributes) decision matrices that contained positive, negative, and neutral information, with the total views and mean time spent viewing each different valence (positive, negative, and neutral information) set as dependent variables. The results indicated that both young and old adults have no emotional information preference in regard to self-relevance. When under no cognitive load, both positive and negative information were viewed more than neutral information; however, under cognitive load, preference for negative information decreased; this effect size was more robust in older adults. There was also a main effect of self-relevance on total views and mean checking time, with attributes concerning higher self-relevance tasks being more likely to attract attention. Older adults exhibited a consistent hedonic focus, even in highly self-relevant contexts; however, this effect disappeared under cognitive load. Overall, the findings suggest that cognitive resources play an important role in emotional information processing during decision processes.     

SenseCam, imagery and bias in memory for wellbeing

Identifying and modifying the negative interpretation bias that characterises depression is central to successful treatment. While accumulating evidence indicates that mental imagery is particularly effective in the modification of emotional bias, this research typically incorporates static and unrelated ambiguous stimuli. SenseCam technology, and the resulting video-like footage, offers an opportunity to produce training stimuli that are dynamic and self-relevant. Here participants experienced several ambiguous tasks and subsequently viewed SenseCam footage of the same tasks, paired with negative or positive captions. Participants were trained to use mental imagery to inter-relate SenseCam footage and captions. Participants reported increased levels of happy mood, reduced levels of sad mood, and increased task enjoyment following SenseCam review with positive versus negative captions. This shift in emotional bias was also evident at 24-hour follow-up, as participants recollected greater task enjoyment for those tasks previously paired with positive captions. Mental imagery appears to play an important role in this process. These preliminary results indicate that in healthy volunteers, SenseCam can be used within a bias modification paradigm to shift mood and memory for wellbeing associated with performing everyday activities. Further refinements are necessary before similar methods can be applied to individuals suffering from subclinical and clinical depression.