科学思维为心肺复苏注入活力

笔者结合近30年临床心肺复苏的实践,系统总结了善用科学思维模式,破解心肺复苏过程中的诸多疑难问题的心得体会,充分阐述了科学思维在获得学术发明成果方面所发挥的巨大作用.     

心肺复苏新观点在临床技能培训中的应用

心肺复苏是急救医学的重要组成部分,也是医学生临床技能培训的重点内容.因此,该技术培训的先进性尤为重要. 2005年由美国心脏学会(american heart association,AHA)和国际急救与复苏联合会(international liaison committee on resuscitation,ILCOR)举办的"2005年心肺复苏和心血管病急诊科学治疗建议国际会议"(以下简称"2005国际会议")在美国达拉斯举行[1].会议完成了心肺复苏(cardiopulmonary resuscitation,CPR)和心血管病急诊领域国际学术界所期待的5年一度的指南修订.此后,复苏学的研究热点集中于新指南的相关变动[2].为使学生掌握最新的操作流程与方法,我们将以往制定的心肺复苏操作培训流程(初级复苏)进行了及时的修改与完善.     

现代复苏的药物应用现状的理性思考

回顾了复苏药物应用研究的现状,运用创新思维的科学方法对现代复苏药物临床应用研究中的医学和伦理难题进行了理性分析,阐明了理论,逻辑思维,哲学思考对临床实践和医学研究的重要性。     

心肺复苏时肾上腺素剂量变迁的思考

肾上腺素是临床上心肺复苏的一线药物,但在最近二十几年以来,其剂量应用方案几经变迁,从20世纪80年代的小剂量,到90年代大剂量方案的兴起,又经历了个体化方案阶段,近几年又重新回归到小剂量给药方案.从唯物辩证法的基本思想出发,阐述心肺复苏时肾上腺素剂量变迁的哲学基础,并运用辩证唯物主义原理来探讨肾上腺素剂量研究的发展方向,这将有助于心肺复苏研究的理论与实践.     

唯物辩证法在院前心肺复苏实践中的指导作用

在院前心肺复苏实践中,我们会遇到很多矛盾的问题。本文从唯物辩证法的角度出发,分析了院前心肺复苏中一些比较棘手的问题,并为解决这些问题提出建议,对从事院前急救的医学专业人士以及非医学专业人士均具有一定的启发意义。     

心肺复苏时肾上腺素剂量变迁的思考

肾上腺素是临床上心肺复苏的一线药物,但在最近二十几年以来,其剂量应用方案几经变迁,从20世纪80年代的小剂量,到90年代大剂量方案的兴起,又经历了个体化方案阶段,近几年又重新回归到小剂量给药方案。从唯物辩证法的基本思想出发,阐述心肺复苏时肾上腺素剂量变迁的哲学基础,并运用辩证唯物主义原理来探讨肾上腺素剂量研究的发展方向,这将有助于心肺复苏研究的理论与实践。     

唯物辩证法在院前心肺复苏实践中的指导作用

在院前心肺复苏实践中,我们会遇到很多矛盾的问题.本文从唯物辩证法的角度出发,分析了院前心肺复苏中一些比较棘手的问题,并为解决这些问题提出建议,对从事院前急救的医学专业人士以及非医学专业人士均具有一定的启发意义.     

唯物辩证法在院前心肺复苏实践中的指导作用

在院前心肺复苏实践中,我们会遇到很多矛盾的问题。本文从唯物辩证法的角度出发,分析了院前心肺复苏中一些比较棘手的问题,并为解决这些问题提出建议,对从事院前急救的医学专业人士以及非医学专业人士均具有一定的启发意义。     

不复苏医嘱的伦理准则

不复苏医嘱的伦理准则［英］ＬｅｎＤｏｙａｌ，ＤａｎｉｅｌＷｉｌｓｈｅｒ娄长春，马世忠译１．下不复苏医嘱的程序１．１不复苏状态意味着，如果患者遭遇心脏停止，则将不呼叫救生队，既不给予基础心肺复苏又不给予晚期心肺复苏。但不含有有关患者治疗的任何其它临床决...     

2005国际心肺复苏和心血管病急救指南的若干问题

2005年国际心肺复苏和心血管病急救指南制订中有5个最有争议的问题以及一些重要的新改变.这5个问题分别是:(1)室颤时,按压与电击何者优先;(2)按压-通气比;(3)一次电击与三次电击除颤的争议;(4)电击剂量;(5)复苏后处理.有利于在心肺复苏和心血管病急救工作中施行.     

妊娠期急性脂肪肝诊治中的科学思维应用

现代科学思维方法中系统思维及模糊思维方法具有普遍适用意义。妊娠期急性脂肪肝临床上极为罕见,并发症多,病死率极高,1例并发腹部卒中的妊娠期急性脂肪肝患者通过科学诊疗转危为安,及时终止妊娠、对症处理、多学科协作联合治疗,积极预防并发症是确保救治成功的关键。本文尝试介绍科学思维方法在该病诊疗中的一些体会。     

Growth: A Journey from Experience to Higher Perception Among Iranian Muslim CPR Survivors

Several studies have been conducted among cardiopulmonary resuscitation (CPR) survivors. Some studies have shown that positive and negative experiences coexist. Emotional distress and psychopathology in CPR survivors are related to the urgent need to make growth. Understanding the meaning of CPR survivors’ lived experiences of growth may facilitate their growth. The aim of the study was to illuminate the meaning of CPR survivor’s lived experiences of growth in southeast Iran. A qualitative design using a phenomenological hermeneutic approach influenced by Ricoeur was used in 12 CPR survivors. Three main themes emerged including: (1) opening up a new horizon in the meaning of life, (2) opening up a new horizon in the meaning of interpersonal connections and (3) opening up a new horizon in the meaning of God and spirituality. The interpreted comprehensive understanding conveyed a meaning that CPR survivors’ experience of growth seems to be like opening the doors of perception to the higher reality. The finding may assist other CPR survivors to learn from participants in this study. Exposure to suitable narratives under health care provider supervision could develop profound learning. Training sessions with an emphasis on meditation education and how to use connecting to God in the adaptation process may approve the quality of life of CPR survivors.

     

诺贝尔生理学或医学奖美国获得者学术条件背景分析

在诺贝尔生理学或医学奖105年的历史中,美国分别占了颁奖年度的52.08%,获奖成果的44.87%,获奖人数的48.91%.形成这些科学家学术优势积累和美国国家科技竞争优势的学术条件背景是:适宜的宏观政策,充足的经费投入,成功的人才政策,根本的教育改革和创新的科技管理.     

From cognition to consciousness

This paper proposes an extension of scientific horizons in the study of animal behavior and cognition to include conscious experiences. From this perspective animals are best appreciated as actors rather than passive objects. A major adaptive function of their central nervous systems may be simple, but conscious and rational, thinking about alternative actions and choosing those the animal believes will get what it wants, or avoid what it dislikes or fears. Versatile adjustment of behavior in response to unpredictable challenges provides strongly suggestive evidence of simple but conscious thinking. And especially significant objective data about animal thoughts and feelings are already available, once communicative signals are recognized as evidence of the subjective experiences they often convey to others. The scientific investigation of human consciousness has undergone a renaissance in the 1990s, as exemplified by numerous symposia, books and two new journals. The neural correlates of cognition appear to be basically similar in all central nervous systems. Therefore other species equipped with very similar neurons, synapses, and glia may well be conscious. Simple perceptual and rational conscious thinking may be at least as important for small animals as for those with large enough brains to store extensive libraries of behavioral rules. Perhaps only in “megabrains” is most of the information processing unconscious. Received: 23 March 1998 / Accepted: 11 April 1998     

从一个康复“缺憾”个案看科学思维方法的意义

本文就一例截瘫患者从因分娩诱发患病、误诊误治到康复治疗实施的过程进行分析,通过总结在诊断、治疗和康复过程中的失误与经验,讨论我们在日常的工作中如何正确建立科学思维方法以及利用科学思维方法解决实际问题,以达到提高自身诊疗水平和独立思考能力的目的。     

Now and Then

I describe my development as a psychoanalyst from my dream of psychoanalysis as a revolutionary movement battling against ignorance and fixed beliefs to finding in Freud's theoretical framework a reliable, scientific base from which I could pursue my own thinking. I trace the evolution of my thinking through my experiences on the training and at my first post-training job in an antenatal department. I give an account of the culmination of my analytic development in my work at Brent Adolescent Centre where my husband, Moe Laufer, and I developed our theory of developmental breakdown in adolescence. Here we pioneered work and research with adolescents in analysis and at the walk-in center.     

The Haunting of the Human Spirit

Understanding the human spirit, the thinking, motivating, feeling aspect of a person, need not entail supernatural reference in any more than a boundary sense. Methodological naturalism accounts for many putatively supernatural experiences in terms of naturalistic and scientific research. Fairy tales have natural functions, naturalistic accounts of miracles can have moral and spiritual power, and neuropsychological research can have value in understanding experiences of ghosts, apparitions, and presences. Even beliefs in personal immortality, at odds with current neurobiology, may serve a range of psychological functions and may raise more moral questions than they answer. Naturalistic accounts can make spiritual explorations possible where supernatural answers provide epistemic barriers.     

The Heritage of Ralph Wendell Burhoe for the Dialogue between Science and Theology: A German Perspective

This paper begins with some reflections on my personal experiences with Ralph Wendell Burhoe during visits to the Chicago Center for Religion and Science. I learned to know Burhoe as an interested and kind person with enormous intellectual power. In this paper I argue that integration of different concepts was the chief focus of his thinking, expressing both an ethical and a dogmatic concern. If his theory of altruism contributes to the scientific investigations into the problem of trans-kin altruism, then his vision of a scientific theology gains credibility. Such an integration is made plausible through the interpretation of altruism in light of Christian love. In fact, Burhoe's neonaturalistic approach may be a fertile resource for the dialogue between science and theology in Germany, and serve as an exemplar of Burhoe's important impact on this dialogue in general.     

Children and adults as intuitive scientists

The metaphor of children and lay adults as intuitive scientists has gained wide acceptance. Although useful in one sense, pertaining to scientific understanding, in another, pertaining to the process of scientific thinking, the metaphor may be fundamentally misleading. Research is reviewed indicating that processes of scientific thinking differ significantly in children, lay adults, and scientists. Hence, it is the instruments of scientific thinking, not just the products, that undergo "strong restructuring" (Carey, 1986). A framework for conceptualizing development of scientific thinking processes is proposed, centering on progressive differentiation and coordination of theory and evidence. This development is metacognitive, as well as strategic. It requires thinking about theories, rather than merely with them, and thinking about evidence, rather than merely being influenced by it, and, hence, reflects the attainment of control over the interaction of theories and evidence in one's own thinking.