临床医师成才规律的调查与分析

运用文献检索、专家访谈、问卷调查等方法,选取若干三级医院医生收集资料并统计分析,探索临床医师培养目标和培养规律。建议针对医师临床能力培养存在问题创新临床医师培养模式:如重视医师医教研全面发展,营造氛围,创新考评与晋升机制,完善职后教育体系,重视中青年拔尖人才培养、进一步端正医师从事科研的动机等。     

哈佛大学专科医师临床研究能力培养见闻及启示

临床医师的科研能力越来越受到重视,在繁忙的日常工作中如何提升临床医师的科研能力尤其是临床科研能力常常是困扰专科医生的重要问题。哈佛医学院是全球顶级的临床与教育机构,笔者通过参与为期一年全球临床学者科研培训(GCSRT)项目学习,亲身体会哈佛医学院这座世界一流大学临床学者科研培训过程,通过观察其培养模式和教育理念,并结合自己在国内带教中的体会进行比较和思考,以期与国内同行在专科医生临床研究能力培养方面进行探讨,共同推进专科医师综合能力的提高。     

关于医疗、科研的一点认识

临床医疗是医院的根本使命,在权重上医疗自然重于科研.医疗实践是科研的出发点与归宿,决定了科研的基本走向.当前,科研工作受到前所未有的重视,科研作为医疗人员绩效考核的权重过大,偏离了医院的根本使命,会对科研、医疗、医护人员乃至整个社会造成伤害.SCI论文与临床关系不密切,不宜用来评价临床医师的水准.应该建立科学的考评机制,考核标准应细化、全面,对科研的奖励应适度.对于医护人员的考核应以医疗为主、科研为辅.     

临床决策与疾病发展的"度"

临床决策是十分复杂的专业劳动,良好而科学的临床决策取决于众多因素,包括医师的临床经验、知识水平、医师的爱心与责任心、患者病情的复杂性、医疗水平与条件、患者及家属的条件与配合程度等等,辩证法的"度"在临床的良好应用会帮助医师准确地把握病情,给予更加适度治疗;真正的个体化临床决策必须由医师与患者及家属的密切配合才能实现.     

临床决策与疾病发展的“度”

临床决策是十分复杂的专业劳动,良好而科学的临床决策取决于众多因素,包括医师的临床经验、知识水平、医师的爱心与责任心、患者病情的复杂性、医疗水平与条件、患者及家属的条件与配合程度等等,辩证法的“度”在临床的良好应用会帮助医师准确地把握病情,给予更加适度治疗;真正的个体化临床决策必须由医师与患者及家属的密切配合才能实现。     

脑出血中医药临床研究的困境与对策

脑出血为临床上的急危重症,目前缺乏有效的中医药治疗。本文从中药汤刺、中药注射剂及针灸三个方面阐述中医药治疗脑出血的临床现状,分析中医药治疗脑出血的优势与不足,从脑出血中医病名的确定、中医病机的多样性及中医重经验、轻理论,重哲学、轻医理等方面剖析中医药治疗脑出血临床困境的原因,并根据所述原因从脑出血相关中医病名研究、脑出血病机研究、中医药新型制弃】研究等方面探讨如何走出中医药治疗脑出血的临床研究困境。     

两幅摄影佳作对临床医师的启示

两幅摄影佳作对临床医师的启示四川省凉山彝族自治州第一医院（６１５０００）冯正中临床医生每天都要接触病人,听取他们的陈述,观察他们的病情,予以必要的检查和处理,并记录于病案。在这种日复一日的平凡临床工作之中,总有一些执著的临床医师成长为科研工作者、科技...     

医学生实习与患者就医间矛盾调和

患者就医希望得到经验丰富的医生诊治,而经验丰富的医师往往由无经验的实习医师通过以牺牲患者利益为代价成长起来的.随着医师法的实施和病人要求的提高,实习医师与患者间的利益冲突构成的这一矛盾更加突出.为化解矛盾,通过提高实习医师业务素质和道德素质,增强临床老师责任心等一系列措施,提高病人对医院满意程度,使实习医师圆满完成实习任务.     

神道与人道——宗教中国化的人文主体北大核心SSCI

夏商周三代国家时期,神道与人道关系从民族文化层面上升为国家体制层面,夏、周两朝重人道而轻神道,商朝则重神道而轻人道,但最终神道向人道转化。至春秋战国时期,随着社会大变革,神道衰微,人道昌盛,中华民族文化从宗教体系转换为人文体系,形成哲学世界观以及社会文化体系,无神论成为社会主流思潮,从此中华民族文化成为一种具有理性思维的世俗文明体系。     

灸法衰落原因的探讨与思考

从产生疼痛、带来创伤、耗时较长等内部原因及重药轻灸、重医轻灸、西医冲击等外部因素探讨灸法自身局限与衰落原因,据此提出灸法技术发展及理论创新的思考.     

Bidirectional Relationships Between Parenting Stress and Child Coping Competence: Findings From the Pace Study

The present study was designed to evaluate the bidirectional relationships between parenting stress and child coping competence. Data from a diverse sample of 610 parents enrolled in the parenting our children to excellence program was used to evaluate whether parenting stress negatively contributes to affective, achievement, and social coping competence in preschoolers, as well as whether child coping competence predicts parenting stress; after accounting for child disruptive behavior. Results from cross-lagged panel analyses demonstrated a bidirectional relationship, such that parenting stress predicted later child coping competence and child coping competence predicted later parenting stress. Assessment of ethnicity differences indicated that child coping continues to have a long-term impact on parenting stress, regardless of parent ethnicity. The same relationship did not hold for earlier parenting stress on later child coping competence, however, indicating a bidirectional relationship for African American families, but not for their European American counterparts. The relationship between parenting stress and child coping competence is discussed with respect to their conceptual and clinical implications. Suggestions for parent training intervention and prevention programs are given.     

The Relationship between Temperament and Life Satisfaction in Early Adolescence: Cognitive and Behavioral Mediation Models

This study investigated the interrelationships among temperament, social self-efficacy, social competence, and life satisfaction in a sample of 160 early adolescents. A model was proposed based on previous research by Argyle and Lu (1990, Personality and Individual Differences 11, pp. 1255–1261) in which social competence mediates the relationship between temperament (i.e. extraversion and neuroticism) and life satisfaction. However, this study extended the work of Argyle and Lu by including an objective measure of social competence, in addition to a measure of social self-efficacy, to test as a potential mediator between temperament and life satisfaction. Results indicated that social self-efficacy mediated the relationship between extraversion and life satisfaction, but not between neuroticism and life satisfaction. Teacher-rated social competence did not mediate the effects of temperament on life satisfaction. The importance of integrating theories of trait psychology and cognitive psychology in adolescent life satisfaction research is discussed.     

Shyness–anxiousness and receptive language skills development in Spanish- and English-speaking preschoolers

The present study utilized a short-term longitudinal research design to model the relationship between shyness–anxiousness and receptive language skills. Hypotheses regarding the direction of the causal relationship, mediation, and moderation were evaluated. Subjects included 340 Head Start attendees from primarily English- and Spanish-speaking homes. Results suggest that a unidirectional relationship between shyness–anxiousness and receptive language skills emerges in preschool. Shyness–anxiousness impacted receptive language skills and this relationship was mediated by communication competence. Neither gender nor native language moderated the indirect relationship from shyness–anxiousness to receptive language through communication competence. These results are discussed with respect to elucidating the nature of the bidirectional relationship between shyness–anxiousness and language skills and identifying intervention targets to improve language outcomes for shy–anxious preschoolers.     

South Korean counselors’ perceived multicultural counseling competence: Relationship with openness to experience,perceived general counseling competence,and multicultural counseling education/practice

This study investigated variables related to the perceived multicultural counseling competence (MCC) of South Korean counselors. The relationship between perceived MCC and demographic information was explored, and effects of openness to experience, general counseling competence, and multicultural counseling education/practice on perceived MCC were examined.  Results revealed no relationship with demographic information and perceived MCC and significant effects of general counseling competence and multucultural counseling education/practice on perceived MCC. Implications for multicultural counseling training and future research are discussed.     

变革型领导对教师职业倦怠的影响:社会情感能力和幸福感的链式中介作用

为了探讨变革型领导、教师社会情感能力、教师幸福感和教师职业倦怠之间的关系,研究采用变革型领导量表、社会情感能力量表、幸福感量表和职业倦怠量表对北京791名教师进行调查。结果显示：（1）变革型领导与教师职业倦怠显著负相关;（2）教师社会情感能力在变革型领导和教师职业倦怠之间起独立中介作用;（3）教师幸福感在变革型领导和教师职业倦怠之间起独立中介作用;（4）教师社会情感能力和教师幸福感在变革型领导和教师职业倦怠间起链式中介作用。变革型领导不仅是直接预测教师职业倦怠的重要外部环境因素,而且变革型领导还能通过教师社会情感能力和教师幸福感这两个内部因素的中介作用间接预测教师职业倦怠。     

Reward allocation decisions of Chinese managers: Influence of employee categorization and allocation context

The purpose of the present study was to investigate the relationships between employee categorization criteria and Chinese managers' allocation behaviors. Using a vignette approach and a four-factor within-subjects design, the effects of relationship (guanxi), loyalty, and competence, as well as their interactions with allocation context (private vs public) were examined. Results showed that subordinates who had a close relationship with the allocator, high loyalty, or high competence were rewarded more. Significant two-way interaction effects indicated that relationship, loyalty and competence interactively affected Chinese managers' reward allocation decisions. In addition, the moderating effects of allocation context on these three criteria were also significant. Limitations of the study and suggestions for further research were discussed.     

The relationships between parenting stress,parenting behaviour and preschoolers' social competence and behaviour problems in the classroom

Young children develop social and emotional competence through interactions with others in the two major contexts in which they spend time: home and preschool. This study examined whether parenting stress in the home context is related to the children's behaviour while in preschool. Previous research has suggested that parenting stress negatively influences parenting behaviour, which in turn has been shown to impact children's development. This study examined the direct relationship between parenting stress and children's behaviour in two types of preschool programmes: private day care centres and Head Start. Parenting stress was significantly related to teacher ratings of social competence, internalizing behaviours, and externalizing behaviours, and the effects of parenting behaviour do not appear to mediate this relationship. Parenting stress was most strongly related to children's social competence. Parents' reports of expectations for their child's behaviour appear to weakly moderate the relationship between externalizing behaviour and parenting stress. This study suggests that examination of a parent's level of stress, in addition to parenting practices, may be important in research and interventions with preschool children's behaviour and social competence. Copyright © 2005 John Wiley & Sons, Ltd.     

跨文化沟通能力对来华留学生抑郁的影响：身份认同差异的中介作用

为探讨来华留学生个人-表现认同差异、个人-关系认同差异在跨文化沟通能力与抑郁之间的中介作用,采用跨文化智力问卷、个人-表现认同差异问卷、个人-关系认同差异问卷、抑郁量表对301名来华留学生进行调查。结果发现：①相关分析表明跨文化沟通能力与个人-表现认同差异、抑郁呈显著负相关;个人-表现认同差异、个人-关系认同差异与抑郁两两呈显著正相关。②链式中介效应检验显示,跨文化沟通能力不能直接影响抑郁,但存在两条间接路径：个人-表现认同差异的单独中介以及个人-表现认同差异和个人-关系认同差异的链式中介。本研究表明,身份认同差异在跨文化沟通能力与来华留学生抑郁的关系中起重要的中介作用,研究结果能为来华留学生抑郁的预防和干预提供有益启示。     

An investigation of the unique,synergistic and balanced relationships between basic psychological needs and intrinsic motivation

The purpose of this study was to empirically investigate the relationship between psychological need satisfaction and intrinsic motivation as proposed by self‐determination theory. Three competing hypotheses regarding the relations between need satisfaction and intrinsic motivation were tested: additive, synergistic, and balance. Two cross‐sectional studies involving 1,254 employees from a broad range of Norwegian service organizations partly supported the first two hypotheses. Although the relationship between satisfaction of the needs for autonomy and relatedness with intrinsic motivation were significant, the one with satisfaction of the need for competence was not. Instead, competence was only related to intrinsic motivation when autonomy was high. Implications for practice and future research are discussed.     

Emotional competence in children with autism: Diagnostic criteria and empirical evidence

The diagnostic criteria of autism spectrum disorders (ASD) include emotional impairments. However, scientific evidence for these impairments is varied and subtle. In this contribution, recent empirical studies that examined the emotional competence in children and adolescents with ASD are reviewed. Four aspects of emotional competence that are important to children’s daily social functioning (expression, perception, responding, and understanding) are discussed, differentiating between mentally retarded and normally intelligent children and adolescents with and without ASD in natural and structured contexts. On various accounts, the emotional impairments of children with ASD that are found in scientific studies provide a more differentiated view on the impairments suggested by the diagnostic literature. Consistent empirical findings and gaps in the field are discussed. Theoretical and clinical recommendations for assessment procedures are suggested.