中国宁养服务发展之我见

1998年 11月李嘉诚基金会捐资在汕头大学医学院第一附属医院兴建全国首家宁养院 ,免费为处于凄苦境地的贫困晚期癌症病人服务 ,并探索出“家居服务、癌痛为主”的服务模式。以此为基础 ,2 0 0 1年李嘉诚基金会再斥巨资与全国2 0家医院协作设立宁养院。它以“以人为本、全人照顾”为宗旨 ,以尽量提高病人及家属生活质量为目标 ;服务方式是家居服务为主 ,即患者住在家中 ,宁养院医务人员定期上门服务 ;服务内容以镇痛治疗为主、以及其它症状控制、心理辅导、家居护理指导、哀伤辅导、宁养知识宣传等。1　目前宁养服务发展存在的问题首先也是最…     

晚期癌症患者宁养疗护与伦理

晚期癌症患者宁养疗护强调人的生活质量与生命价值,其在实践中得到了长足的发展,正成为姑息医学中的重要部分。随着医学向生物心理社会医学模式转变和姑息医学快速发展,宁养疗护伦理问题日益凸显。宁养疗护伦理在医疗方面强调适度治疗与合理用药,护理方面强调患者生理、心理、灵性、社会和宗教等层面的整体性照顾。梳理宁养疗护伦理有利于在宁养疗护服务中做出最优伦理选择,这种选择需遵循不伤害原则,注重生命质量原则、适度治疗和舒适生存原则、尊重患者意愿原则以及公平正义的原则。     

宁养的概论及实施

宁养为结合团队力量,在患者面临生命末期时,协助其可以面对身、心、灵、社会之整体性的痛苦,关心患者的心声、生命的意义、生活的维持、使患者被治疗、关怀、尊重、倾听、接受及了解,有尊严地面对死亡。照顾者依自己的需要关心、照顾自己,宁养团队成员需装备好自己,了解面对的病患问题,给予全人的照顾,使患者善终,家属善生。     

导言：优逝——生命关怀中的题中应有之意

众所周知,“计划生育,优生优育”是我们的基本国策,讲的是生命的“起始”;那么,生命的“终结”——死亡呢,“优逝”的问题是不是也应该提到日程上呢？答案应该是肯定的。因为,关注“优逝”本来就是生命关怀中的题中应有之意,既由生命有始有终的固有特质所决定,也为时代前进、医学发展、宁养疗护服务理念的普及所要求,更是社会文明发展的重要标志。     

宁养医学课程与医学生人文关怀

介绍宁养医学的定义,在医学生中开设宁养医学课程的做法、体会和存在问题.在此基础上,提出了宁养医学课程有助于在医学生中普及照顾不可治愈病人的原则和知识,培养人文关怀的理念,因此建议将其列为必修课.     

关于加强高等医学院校人文社会医学教学与学科建设的建议

近半个世纪以来 ,随着医学科学技术的迅速进步 ,医学高新技术引发的社会、伦理、法律问题日益增多 ;由于医疗诊治手段日益高技术化 ,医患间的直接交流与沟通急剧减少 ;以追求特异性诊断和治疗为目标的现代医学在对付慢性病、老年病方面成效受限 ;医疗保健服务市场化取向的提升和医疗费用大幅上涨 ;以及病人权益意识的增强 ,医疗保健服务面临着前所未有的挑战。医学是以人、人的生命、人的健康为服务对象 ,其本质为“人性化的医疗” ,是奠基于人文、科学、哲学的学问。但是 ,长期以来 ,我们在医学教育中 ,只侧重于科学教育和技术层面的训练 ,…     

第四讲:循证医学与急救医学

急诊医学是一门新兴学科,在借鉴国外先进经验的同时,自身也得到迅速发展.急诊医学作为医疗和社会保障体系的重要部分,在抢救急危重症病人生命、应对灾害和突发事件中发挥了极为重要的作用.急诊科的工作特点是病情急、病人急、病人家属急和医生的急救处理,因此,要求急诊科医生应具有内、外、妇、儿等多学科的专业知识,需要有及时正确判断处理病人的综合能力,也需要有更确切、更可信、更实用的临床证据指导医生急诊救治.如何在这门新兴的学科中应用循证医学的理念,掌握循证医学的方法,进行临床研究和面对病人,更好地为病人服务,是急诊医学面临的挑战.     

弘扬医学人文精神，规范冠心病治疗

医学不仅是一门科学,更是一门“人学”。医学与人文密不可分,可以说医学人文是医学的灵魂,而医学和人文是医生的两翼,缺一不可。但是,当前的医学无论是从医疗服务的公平性、医患诚信的丧失,还是从紧张的医患关系来看,医学人文观念已经变得日益淡薄,同时医疗高新技术的广泛应用也使得医学人文问题日益突出。如何使医学回归人文,如何强化医疗服务的人文性,不仅是患者及社会关心的问题,同时也是医学界必须面对的问题。     

关于调整医学目的与服务模式若干问题的研究提纲

关于调整医学目的与服务模式若干问题的研究提纲中华医学会医学伦理学会（１９９５年１月）医学目的与服务模式是一个涉及医学科学与医疗卫生事业全局性问题。本会自１９９４年１１月决定开展“医学目的·生命质量·医学伦理”的讨论以来,全国２５个省市近３００余名从事...     

面对医疗技术主义的若干思考

现阶段 ,我国医疗卫生服务水平和医疗消费水平的飞速提高 ,不可避免地滋生了医疗技术主义的现象。面对医疗技术主义 ,人们从医学与哲学辩证法得到的思考是 ,医疗技术主义是我国社会主义医疗卫生事业整体发展的不利因素 ,对不良的高医疗消费有明显的医疗责任 ,对其进行有效遏制是现时命题。1　关于医疗技术主义把医学科技服务单纯技术化 ,追求利润极大化 ,机械性并数量化的现实施加于病人的强加性矛盾医疗服务状态称为医疗技术主义。在医学发展的根本趋势下 ,医学的现实和走向与公众身心健康密切关联 ,除相适应的一面 ,至少也存在与社会公众…     

中国大陆宁养照顾对癌症末期患者生活质量之影响

宁养工作强调全人的照顾,不但能维持原有的生活方式,而且能提高生活的品质。本研究旨在探讨癌症末期患者在宁养照顾介入后,生活质量的改变。研究分为试验组（n=630）和对照组（n=241）。研究的结果显示癌症末期患者经过宁养介入后,其身、心、灵、社会之生活品质大幅度改善。而对照组患者仅在身体生活质量方面有显著改变。因此对医疗人员、社会大众的临终关怀观念的推广及教育是迫切需要的,立法更是不容忽视的课题,正确的立法才能真正推动宁养工作的发展。     

The Unmet Educational Agenda in Integrated Care

One of the reasons integrated care has not become a dominant service delivery model is the unmet training agenda. This article argues that the typical mental health professional is not trained to adequately address the challenges of integrated care. To insure competency both a macro and clinical training agenda are needed. At the macro-level, mental health professionals need to understand healthcare economics and basic business principles as any integrated care service delivery system is embedded and driven by economic forces. Integrated care practitioners also need some basic business skills to understand these forces and to create and manage a financially viable system, given the future flux of the system. Traditional mental health professionals also do not have the clinical skills to implement integrated care. Integrated care is not simply placing a traditionally trained mental health professional and letting them practice specialty mental health in a medical setting. Thus, the special skills needed in integrated care are enumerated and discussed. Finally, a new degree program is described as it is time given the huge need and advantages of integrated care to develop specialty training in integrated care.     

Ethics and Changing Mental Health Care: Concerns and Recommendations for Practice

Recent developments in health care delivery in the United States have left many professionals baffled by the continuing changes in practice sparked by the relatively new managed care environment. Psychologists who practice in medical settings are struggling to balance the seemingly competing needs to deliver quality care to clients and patients, while meeting the demands of third-party payers and trying to remain true to their ethical responsibilities. Critical elements of managed care, which many suggest compromise the ethical provision of quality care, include utilization review, financial incentives, and threats to confidentiality. Recommendations are proposed so that mental health professionals may be proactive in protecting their ethical responsibilities in this changing environment.     

下腰痛综合征的诊治与人文思想

下腰痛是一种常见的骨科病症,轻者可影响患者生活,重者可使患者丧失劳动力。它的发病原因有很多,治疗方法各有不同。在下腰痛的诊断中要按照适度医疗的原则选择合适的检查;在下腰痛的治疗中须按照最优化医疗的原则选择最佳的治疗方案。在治疗中要注意结合人文思想来提高下腰痛的治疗效果。     

Health care utilisation in patients with non-cardiac chest pain: A longitudinal analysis of chest pain,anxiety and interoceptive fear

Chest pain can be a frightening experience that leads many to seek medical evaluation. The symptom results in costly health care utilisation. Over half of patients referred for cardiac evaluations of chest pain do not obtain definitive medical explanations for their symptoms; these cases are described as non-cardiac chest pain (NCCP). Some patients with NCCP are not reassured after being informed their chest pain is non-cardiac in origin and seek repeated medical evaluation. Co-morbid anxiety and mood disorders often coexist with NCCP and are associated with health care utilisation. The current study examined chest pain, general anxiety, interoceptive fear and health care utilisation in a sample of 196 chest pain patients near the time of cardiac evaluation (Time 1), and 70 of these patients one year later (Time 2). Results indicate that anxiety and interoceptive fear were significantly associated with health care utilisation at Time 1, and only interoceptive fear (at Time 1) predicted health care utilisation at Time 2. This study develops research in this area by examining the relation of anxiety and health care utilisation longitudinally in patients with NCCP.     

谈《疏五过论》的五种过错对当今医生的教育意义

传统的医学道德观认为：“医乃仁术”、“生命至贵”等就是“‘大医精诚”。医者要做到“大医精诚”,就要避免《疏五过论》中医者的五种过错,使患者保持健康的生命。所以,医生要以严谨认真的工作态度,充分了解患者的病情;以生物心理社会医学模式来处理患者;不能急功近利,追求名誉,应常怀仁爱之心建立和谐的医惠关系。医生处理患者的态度及自身的道德修养直接影响患者的健康和生命,这种理念应该成为医生终生追求的目标,这样才能顺应新医改的要求。     

重视人文关怀,促进检验科管理及服务水平的提高

在当前检验医学日趋呈现＂人文缺失＂的背景下,提出加强检验人员人文素质教育的必要性及紧迫性,并重点阐明以患者需求为导向,提高检验科人性化服务的具体措施。     

Performance of Mental Health Counselors in Integrated Primary and Behavioral Health Care

Integrated primary and behavioral health care (IPBH) is becoming a preferred mode of service delivery in the United States. Integrated care includes the participation of medical and mental health professionals, such as mental health counselors. The clinical outcomes of these professionals need to be studied to determine their effectiveness in such settings. We examined the performance of 10 mental health counselors on the clinical outcome of 1,747 clients treated in an IPBH center. Analyses using growth curve modeling and pre‐post test design revealed that mental health counselors were effective overall, but they differed in client dropout rates and efficiency in reducing clients' initial symptoms. We used the analyses to rank order counselors based on their effectiveness. Counselors who were the most effective varied in their efficiency but demonstrated the lowest client dropout rates. Implications for future research and counseling practice were discussed.     

精准医疗的理念及其技术体系

精准医疗模式本着患者的最大获益和社会医疗投入的高效配置为宗旨,结合现代流行病学和预防医学、临床诊断学和治疗学、分子医学、医学信息学技术以及卫生经济学和医学社会学,使传统的医疗模式走向整合化,为每一个人提供量体裁衣般的疾病预防、筛查、诊断、治疗和康复计划,以最小资源投入获取最大健康保障,从而提高整体人群的健康水平。     

L’abord de la sexualité par les professionnel·le·s de santé en oncologie : une revue de la littérature

The improvement in medical techniques has drastically modified the practice of care in oncology. Supportive care, geared towards supporting patients with chronic illnesses, now occupies a greater place alongside treatments aimed at survival. These changes have conducted some health care professionals to be more interested in patients’ quality of life and, in particular, to the impact of cancer on sexuality. Repercussions on sexuality are actually one of the most problematic aspects of patients’ quality of life post cancer. The aim of this paper is to draw up a review of the English and French literature on this “new” concern which still seems to raise many challenges in practice. Our review emphasizes that despite the recognition of the importance of addressing sexuality issues post cancer in oncology, in their practices, physicians as the nurses alike find it difficult to address. In addition, it underlines that the dominant social representations of sexuality – in terms of gender, sexual orientation and age – have permeated health care professionals’ subjectivities and, at the same time, influence how sexuality is address and interfere with a systematic discussion of these issues throughout the care process. Our discussion tackles the lack of psychologists, both in research and clinic, regarding these issues. Finally, our conclusion highlights the contributions of psychology facing issue posed by sexuality in oncology.