医学专业精神及医疗保密：美国历史及现状中的冲突

讨论卫生部门宣传和加强强制汇报的法律的努力、强制性汇报的规定与医学专业精神及个人自主性之间的冲突、私人医生避免遵守这些规则的策略、病人和倡议者设法避免强制性登记和检测的策略,以及医生/病人和公共卫生官员达成的妥协。最后对公共卫生政策提出建议,认识到强制性汇报存在的问题和卫生政策透明度的重要性。     

医生与药业的关系:利益冲突重要根源

药业与医生的关系在最近40年日益受到医学界与社会的重视.药业以并不昂贵的馈赠及其他手段,资助学术交流、医学教育和医学研究,深刻地影响着临床医生的行为和诊治决策,从而危及医学的科学性和医学职业精神,加重了病人的负担,且祸及病人健康.药业与医生的这种关系,是道德与金钱关系的赤裸表现,是资本对医学的无情侵略.从道德、法律、行业管理等诸多方面正确规范行业与医生的相互关系,避免当前面临的种种弊端,维护医学的科学性,保护病人与社会公众的利益,刻不容缓.     

公共卫生领域非传统安全威胁及应对

医学公共卫生领域非传统安全威胁历来是而且当今仍然是威胁人类自身生存的重大社会安全问题.重大传染病的暴发、自杀、现代医学高科技等现象动辄呈现出全球化趋势,尤其是SARS的爆发,突出了公共卫生的重要性,给我国公共卫生的管理及政策制定提出了更高要求:应真正建立起以"预防为主"的公共卫生体系,加强中国与国际的安全合作,加强公民的医学和健康教育.这是由公共卫生本身的性质和时代的发展共同决定的.     

准确、完整的诊断与临床决策

正确的诊断是正确的临床决策的基础,正确的诊断依赖于详细的病史、准确全面的体格检查、合理的辅助检查资料的分析及正确的临床诊断思维方法.如果其中任何一项被忽视,临床医生可能会做出错误的诊断和错误的治疗,给病人造成不必要的损害.为了避免上述情况的发生,临床医生必须在掌握全面的临床资料的基础上,加以科学的综合分析,这样才能得出正确的诊断,给病人以正确的治疗.     

临床医学生公共卫生教育的现状与对策

公共卫生是我国医疗卫生体系的重要组成部分.从医学教育的源头上加强临床与公共卫生的联系,通过宣扬"大卫生观"、改组教学计划、注重教师资质、调整配套教材、改进教育方法等对策,有助于培养具有足够公共卫生意识和群防群治能力的临床医生,促进医疗事业的良性发展.     

美国医生对于医疗坏消息告知的程序及具体方法

坏消息的告知是临床医生遇到的较为困难的情况之一.从交谈的环境、告知的开始、继续交谈、对病人情感反应的评价及处理、病人的遗愿5个方面详细介绍了美国医生对于医疗坏消息告知的程序及具体方法,从而为我国医生提供参考.     

国外临床决策研究进展(下)

4 公共卫生服务研究和诊疗策略的关系国际医学决策学会在分析临床实践诊治策略与治疗指南的关系的同时,又十分重视公共卫生服务的研究.在2004年年会上提出了公共卫生服务研究的方法和应用;在2005年和2008年的年会上又将公共卫生服务研究和诊疗策略作为讨论议题.     

关注现代公共卫生的政策框架

2003年肆虐中华大地的"非典"疫情,最重要和最显著的社会影响是,人们重新"发现"和"回归"似乎已经久违的公共卫生,社会发展和社会转型迫切需要公共卫生,公共卫生在社会发展与社会转型中占据战略地位:公共卫生既是公共管理和公共政策议程中最优先的议题,又首次真正形成"公共卫生"议题.更重要的是,SARS疫情迫使人们反思传统公共卫生政策框架与医疗卫生制度的整体安排,重新思考政府在社会协调发展与公共卫生领域扮演角色、发挥作用,政府与市场机制关系,直接刺激推动传统公共卫生政策框架与服务体系向现代公共卫生政策框架与服务体系转变,这种转变既成为传统社会向现代社会转型不可或缺的重要组成部分,又成为推动公共财政体制建设、社会政策框架建构、社会福利制度创新和公共管理的最佳社会契机,意义重大非凡.     

患者门诊话语中确认性问句的信息索取功能

确认性问句是门诊患者使用最多的向医生索取核心医学信息的间接方法.经考察这种兼有信息索取功能的确认性问句的功能、语言形式、内容、医生的答句各方面的特征,得出结论:这种确认性问句是病人综合考虑其目的和利益及其在医患角色关系中所处的地位、医生心理、语用原则、当前医患关系现状各因素后所选择的语言策略,医生应该认真对待.     

医生的利益冲突 《美国医学会杂志》

正1利益冲突:为什么重要维护信任是有关利益冲突政策的基本目的。医生有许多重要的作用,包括照料病人、保护公众健康、从事研究、报告科学和临床发现、制定和恪守专业准则,以及向制定政策者和管理机构提供建议。在所有这些职能方面获得成功要依赖其他人(外行、专业同行和政策领导人),他们相信医生的话,并按他们的话去行动。因此,其他人信任医生的判断具有头等重要的意义。当对医生的信任受到损害时,医生的作用就降低了。     

Seeing and hearing and space and space and time

A previous experiment had shown spatial location to be judged in terms of the framework provided by the modality in which stimuli were presented. In the present study, digits were either auditorally or visually presented, and in either form the three digits appeared successivly to the left, in the center, and to the right of the S. The digit which occurred temporally in the middle of the sequence was never central from the spatial viewpoint. The S was asked to indicate which digit was the middle one. Ss were blind, deaf, or normal. The deaf and two control groups saw visual displays, and the blind and their controls heard auditory displays. The former groups predominantly chose the spatially middle digit and the latter groups the temporally middle. It was concluded that modality of presentation was the trigger which switched in the coding dimension of time or space.     

Bob and Carol and Tess and Ali

Conflicting religious experiences in different traditions do not necessarily defeat the rationality of conflicting beliefs sustained by those experiences in those traditions. The circularity that protects religious beliefs from such mutual defeat is not vicious. Moreover, the lack of ‘epistemological humility’ exhibited by such believers poses no threat to world peace. In fact, a campaign for compulsory humility would itself constitute a much greater threat.     

Law and Gospel,and Youth and Family Ministry

Abstract : If “faith comes through hearing” the word of God comprised in law and gospel, how do the imperatives that characterize ‘Youth and Family Ministry’ make such hearing possible? Here, literature delineating ‘Youth and Family Ministry’ is analyzed in light of its biblical foundations. The primary lens implemented in this analysis is the law/gospel hermeneutic advocated by Martin Luther and other reformers.     

Extremes of self-esteem and narcissism and the experience and expression of anger and aggression

This study examined the level of self-esteem and narcissism as personality variables involved in the disposition to experience and express anger. Three hundred thirty-eight subjects were sampled across two higher education centres and one student teaching programme in the United Kingdom. It was reasoned that individuals with both high self-esteem and narcissism would report especially high tendencies to experience and express anger and aggression and that those with high self-esteem and low narcissism would report the lowest. These predictions were influenced by theories that emphasise the role of threats to high self-esteem in the production of aggression and violence. Results indicate that groups defined by their extreme scores on self-esteem and narcissism scales produced levels of anger expression in the predicted direction. The importance of considering extreme levels of self-esteem and narcissism (in conjunction with other factors) in an analysis of anger is discussed with reference to currently influential theories in the field. Aggr. Behav. 24:421–438, 1998. © 1998 Wiley-Liss, Inc.     

Dance and psychotherapy--possibilities and limits

From a starting point of therapeutic and prophylactic components identifiable in the dance, the authors regard the dance as deserving of greater attention than was hitherto the case in programs of physiotherapy, psychotherapy, and sociotherapy. From the existing essays at a therapy basing on body and motion, they infer basic common points, and to promote discussion, they state their attitudes in respect of the potential and rank of the dance in the concept of complex multimodal psychotherapy.     

Yin and Yang,and the Hot and the Cold

Yin and Yang are important concepts in ancient Chinese philosophy.Western scholars have become more familiar with these two concepts recently,but for a long time almost no one considered comparing them with their own tradition such as the ancient Greek philosophy,and especially with the ideas of the Hot and the Cold in Presocratic philosophy.In this paper,I make an attempt to do exactly that,and especially make a detailed comparison between the thoughts of two ancient thinkers:Laozi and Anaximander.I discuss the thought of Yin and Yang in Laozi-who was the earliest philosopher making use of the concepts Yin and Yang-to express his cosmological thought in ancient Chinese philosophy.Comparatively,I discuss the ideas of the Hot and the Cold in Anaximander,the earlier among Presocratic philosophers referring to the Hot and the Cold as fundamental concepts used to establish his cosmological system.Through this comparison,I indicate that the similarity between ancient Chinese and Western traditions is far more significant than what people are used to imagining.     

Perversion and infancy and adolescence

Abstract

Studying the works of Freud and Lacan, the authors carried out research on perversion in childhood. Their work covered the perverse polymorphism of infantile sexuality and the perception of the anatomic difference between the sexes that leads the child to create sexual theories and fantasies. The phallic mother and the fetish are viewed as imaginary solutions directly related to the Oedipus and castration complexes. In perversion, a particular position is taken in relation to the Oedipus complex: a serious flaw occurs in the symbolization of the law, and the mechanisms of denial and disavowal take form. Sexuality requires a second “logical time,” separated from infancy by the latency period, in order to confirm (in action) that a fixed position of jouissance (enjoyment) has actually been established. This can only happen in a period after adolescent enhancement. The distinction between perverse traces and a perverse structure is made, taking into account the fact that, in the case of child analysis, the analyst should free the child from the family fantasy and help him/her to build his/her own fantasy.

Campos Santoro V. et al. Perversion und Kindheit und Adoleszenz.

Im Studium der Arbeiten von Freud und Lacan haben die Autoren Forschung über Perversion in der Kindheit gemacht. Die Studien behandeln den perversen Polymorphismus der infantilen Sexualität und die Wahrnehmung des anatomischen Unterschiedes zwischen den Geschlechtern, welche das Kind dazu führt, Sexual-Theorien und Phatasien zu schaffen.

Die phallische Mutter und der Fetisch werden als imaginäre Lösungen angesehen, die sich direkt auf den Ödipus- und Kastrations-Komplex beziehen. Bei der Perversion wird eine besondere Position in Bezug auf den Ödipus angenommen; ein ernsthafter Mangel tritt bei der Symbolisierung des Rechts auf; die Mechanismen der Verneinung und der Verleugnung bilden sich. Sexualität erfordert eine zweite “logische Zeit”, von der Kindheit durch die Latenz Periode getrennt, um (in der Handlung) zu bestätigen, daß eine fixierte Position der jouissance (Vergnügung) sich tatsächlich etabliert hat. Das kann sich nur in einer Periode nach der adoleszenten Verstärkung ereignen.

Es wird die Unterscheidung zwischen perversen Spuren und einer perversen Struktur gemacht, in Rechnung stellend, daß im Fall der Kinder-Analyse der Analytiker das Kind von der Familien-Phantasie befreien sollte und ihm/ihr helfen sollte, seine/ihre Phantasie auszubilden.

Campos Santoro V. Perversión e infancia y adolescencia.

Estudiando los trabajos de Freud y Lacan, los autores han investigado la perversión en la niñez. Los estudios cubren la sexualidad infantil perversa polimorfa y la percepción de la diferencia anatómica entre los sexos, que llevan al niño a crear teorías sexuales y fantasías.

La madre fálica y el fetiche son vistos como soluciones imaginarias relacionadas directamente con el complejo de Edipo y de castración. La perversión, toma una posición particular en relación al Edipo; un fallo importante tiene lugar en la simbolización de la ley; los mecanismos de negación y repudio toman forma. La sexualidad requiere un segundo “tiempo lógico” separado de la infancia por el periodo de latencia, para confirmar (en acto) que una posición fija de jouissance (goce) se ha establecido. Esto solo puede ocurrir en un periodo posterior a la intensificación adolescente.

La distinción entre las huellas perversas y la estructura perversa se ha hecho, teniendo en cuenta que, en el caso del análisis de niños, el analista debe librar al niño de la fantasía familiar y ayudar a el/ella a construir su propia fantasía.     

神圣、凡俗与净明、忠孝

本文结合有关宗教学理论,对宋元净明道所推崇的"净明"、"忠孝"概念进行了解析.作者以为:宋元净明道视世俗性的道德实践为"神圣"的宗教修炼,实与宗教学中的凡俗可以"转换"为神圣之理论相合;而净明道徒的这种"转换",则多与其个体的"宗教体验"有关.至于元代净明道借"无极"概念来释"净明",以"净明"为回复宇宙根源之境界,则合于宗教人经验到与万物的根源、终极的本体或神圣的世界契合之感.换言之,宋元净明道的"净明"、"忠孝"说,实与各种宗教的本质有着相通之处.