精神疾病共病现象的辩证思考

由于大多数精神疾病的病因和发病机制不明,无特异性的生物学诊断指标,临床表现多样,有时很难用一种疾病解释.共病的概念应用于精神科临床,为精神科医生提供了一种辩证的诊断思维方法,对研究共病的本质和指导临床治疗都有重要的意义.     

浅谈自发性脑出血诊断的辩证思维

自发性脑出血作为临床常见疾病,其背景复杂,对其予以准确诊断较为困难。除最常见于高血压性脑出血外,其既可作为某些疾病的首发表现,也可作为其他疾病的并发症或某些药物治疗的副作用而出现。其准确诊断除需具备完整临床知识结构外,亦要求我们具有辩证思维。本文旨在从辩证思维和临床角度探讨自发性脑出血的准确诊断。     

急腹症2例误诊分析

急腹症是外科常见病和多发病,它是一种以急性腹痛为主要表现的临床急症,临床上常有误诊发生,最终造成严重后果。因而在诊疗过程中,必须对急性腹痛尽快作出定位、定性及病因诊断,以防误诊误治。现将我科收治的子宫穿孔误诊为消化道穿孔和输卵管卵巢脓肿误诊为阑尾周围脓肿的2例以急腹症表现为首发症状的患者在我科室的诊治过程及经验进行总结并进行分析,为临床能够提高急腹症的诊率断,降低误诊率提供借鉴,提高临床医生的鉴别能力,保证患者的身心健康。     

羊水栓塞诊断的临床决策

临床决策已成为临床医学的重要内容,但目前仍被许多妇产科医师所忽视。通过阐述临床决策的概念及意义,分析了羊水栓塞诊断中应该注意的问题,探讨了如何建立科学的羊水栓塞诊断的临床决策。为了提高临床决策的效率和准确性,减少或避免各种失误,需要建立一套合理的临床思维方法和科学的处理程序,为羊水栓塞的治疗提供科学的决策方法。     

Bartter综合征的研究进展

Bartter综合征（BS）是一种内分泌与肾脏功能紊乱的遗传代谢性疾病,分子遗传学表明为离子通道基因突变所致,各年龄段均可发病,主要见于儿童时期,临床罕见。因为许多临床医师对本痛缺乏认识而易延误诊治。若能及时治疗,可较好地控制病情,改善患儿生活质量,减少后遗症的发生率和病死率。近年来,BS的发病率有逐渐上升趋势。因此,本文对BS的发病机制、临床表现、诊断与治疗的研究现状做一总结,旨在提高临床医师对本病的认识,争取做到早诊断早治疗,改善患儿预后。     

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。     

疾病诊断谁说了算：临床诊断？影像诊断？

影像诊断是临床诊断的一个重要组成部分,与问诊、体格检查、实验室检查等一同构成临床诊断。影像诊断不能脱离临床诊断工作而单独存在,影像诊断的结论是否正确需要其他非影像学证据的支撑,其结论不能脱离症状、体征而存在。影像诊断专注于分析图像特征、从图像中寻找诊断证据,不需要采纳其他非影像学证据完善其结论;由于影像诊断是完全来源于图像分析,因而具有不可避免的局限性。影像诊断和其他诊断技术的融合推动了临床诊治技术的进步。     

关于多发性骨髓瘤的诊断

多发性骨髓瘤是浆细胞克隆性增生的恶性肿瘤,起病隐匿,临床表现复杂多样,且无特异性,诊断上依赖实验室检查。临床上对该病足够的认识,正确诊断尤为重要。在诊断中,科学地应用哲学思维,有助于减少误诊和漏诊。     

对于提高X线平片诊断准确率的思考

在临床实践中由于X线诊断方法具有操作简单方便、影像直观、空间及整体定位高及价格低廉等的优势,是其他影像检查不可替代的.但是X线平片显影主要是骨组织,X线平片检查伪影发生概率相对较高,为诊断的准确性带来了困难,X线影像诊断的误诊在临床工作中也是不可避免的,作为医务工作者总是要努力做到把误诊和漏诊减少到最低限度.本文就X线平片诊断医生在临床工作中要树立的诊断观念、拥有的读片方式、遵循的思维方法以及最后的报告书写,结合工作实践来探讨了对疾病的诊断,避免诊断结果对临床医生的错误导向.     

酒精性脂肪性肝病与非酒精性脂肪性肝病的对立统一

脂肪性肝病从病因上分为酒精性和非酒精性FLD,两者在临床诊断标准、分型、针对性治疗措施方面显著不同;但在防治目标、非药物治疗、保肝护肝等基础治疗方面又是一致的,这种对立统一的关系对我们的临床诊疗有着重要的指导意义,在临床实践中需要通盘考虑。     

精神医学中的信息系统控制原理

精神医学是临床医学的一个分枝,是高度复杂的一门科学,站在哲学的角度反思,信息系统控制科学方法渗透于精神医学的历史发展过程和临床工作的资料收集、诊断、治疗等各个环节,以及精神医学的科研工作中,还启迪着我国精神卫生事业的发展方向。     

What is diagnosis? Some critical reflections

It is argued that the common definition of diagnosis as ‘the determination of the nature of a disease’ is misleading. Many diagnoses are not the names of disease entities. This finding reflects the integral relation of the diagnostic task to the rest of clinical reasoning. Diagnosis has no separate goal of its own, in particular it does not have the goal of determining the nature of a disease. Instead, diagnosis contributes to the general goals of clinical medicine. Any attempt to model diagnostic reasoning abstracted from the rest of clinical reasoning will yield an inadequate representation of diagnosis. Such a distortion of medical reasoning will blind us to whatever implications an adequate epistemology of medicine may have for an understanding of the relation between theoretical and practical knowledge in other contexts.     

Clinical psychology—Art or science

This paper questions the oft-repeated statement that clinical psychology is an art by examining the main functions of clinical psychologists, i.e., diagnosis and treatment. In examining the concept of diagnosis, evidence is presented which supports the notion that a diagnostic statement has meaning only when it has a referent in the future—when it provides a prediction. A prediction (probability-statement) is determined empirically and may be stated in terms of a regression equation or in terms of a crude generalization from clinical experience. Treatment likewise is determined by tacit or expressed predictions of behavior under alternative conditions. The various conceptions of art as applied to clinical psychology are examined and the conclusion is drawn that clinical psychology is a scientific as opposed to an artistic or intuitive enterprise.Paper read at the 49th annual meeting of the American Psychological Association at Evanston, Illinois, September 3–6, 1941.This analysis may be applied with little modification to the fields of social work, psychiatry, vocational guidance, and related professions.     

The weighing of pathological and non-pathological information in clinical judgment

On the basis of the classic data of Meehl (1959), I examine how clinical psychologists use the MMPI scales to judge the degree of pathology of psychiatric patients by comparing linear models of the judgment to a linear model of the criterion (the actual diagnosis of the patients). This comparison reveals that excessively heavy weight is assigned to pathological information in comparison to non-pathological information. Additional analyses reveal that this biased weighing also influences the actual diagnosis and that it is a major determinant of the accuracy of clinical judgment. It is suggested that these effects arise from a confirmation bias associated with the hypothesis that a patient has severe, rather than mild, pathology.     

食管癌早期诊断方法的哲学思考

食管癌早期诊断方法和技术,涵盖了医学科学、放射技术、光学及电子技术、计算机技术等相关高新技术学科。回顾食管癌早期诊断方法和技术的历史发展,不难看出,临床需求是引发技术创新的原动力,多学科交叉合作研究是加速新技术研制和推广的前题,新技术的开发应用必须以临床和基础研究为基础。科学技术进步推动了医学发展,早期诊断方法和技术的不断发展和进步对降低食管癌发病率和死亡率起着重要作用。     

学习与推行“恶性肿瘤诊治规范”是临床（肿瘤）医生紧迫而持久的任务

恶性肿瘤是迄今威胁人民生命健康最常见、最凶险的一大类疾病,关于它的诊断和治疗,既十分复杂而又涉及多学科协作,制定一种权威性的临床肿瘤诊治规范或指南,去规范临床(肿瘤)医生的医疗实践,有着多方面的重要意义,学习与贯彻指南需要采取一系列措施。     

Developmental theory and the practice of clinical child psychology

Examined developmental theory and its relevance for the practice of clinical child psychology. Following a brief review of basic principles of developmental psychology and developmental psychopathology, implications of a developmental perspective are explored for the diagnosis, assessment, and treatment of childhood disorders. Although it is obvious that many developmental issues confront the clinical child psychologist and that we have learned much about translating developmental theory into clinical practice, we conclude we have a long way to go before we can assert that a true developmental-clinical child interface has been realized.     

急性胰腺炎临床决策中的辩证思维观

急性胰腺炎（AP）是临床常见危重症。近年来AP诊断和治疗取得了令人瞩目的进展,及早诊断和恰当、合理的生命支持治疗极大改善了AP患者的预后。临床上AP患者病情往往复杂多变,要求在极短时间内做出正确的临床决策,科学理性的临床决策思维对AP患者的合理诊治起着非常重要的指导作用。临床医师应努力学习和充分灵活地运用辩证思维,为对AP进行科学的临床诊疗决策提供合理的思路。