医患关系何解？——医者患病经历文献述评

综述医者患病经历相关文献发现,医、患分野和矛盾植根于医学和医学模式本身,是在现代医学发展过程中被建构出来的,解决医患关系问题应着眼于审视和改变医学文化和医学模式内部造成医患矛盾、分歧的根本原因,创造机会打破严格的医、患角色区隔,实现病人得治、医者得安、医患共同。在医者患病经历文献中,能追溯医患同源的起点,能洞悉医患分化和冲突所在,也能看到形成医患共同体的可能性,为实现和谐医患关系指明方向。

     

葡萄入药史考述——以中医药典籍为中心

葡萄是通过丝绸之路传入中原的物质文明,葡萄一入中原,即被广泛使用,可食用、可酿酒、可入药。中文文献记载的葡萄入药最早见于《神农本草经》,此后历代医家不断积累和完善葡萄入药经验,葡萄果、葡萄根、葡萄籽、葡萄叶等均可入药。学界研究葡萄的成果丰富,但研究葡萄入药的成果却甚少。通过详细梳理中医药典籍中的葡萄相关文献,探讨葡萄在中医药典籍中的演变历程,总结历代医家使用葡萄的经验和规律,在此基础上研究葡萄在中医药发展史上的意义和药用价值,并为现代医药学家使用和发掘葡萄丰富的药用价值提供借鉴。

     

临床护理人员的护理伦理知信行素养调查研究——以某三甲医院为例

为了解临床护理人员的护理伦理知识、信念、行为等素养的现状、存在的主要问题及其主要影响因素,问卷调查了某三级甲等医院的1147名护理人员,同时对16名资深护理人员和护理工作管理者进行深入访谈。调查结果显示,尽管多数护理人员在工作实践中能正确践行护理伦理行为,但护理人员的护理伦理知识欠缺,护理伦理教育有待加强;部分护理人员的基本护理（医学）伦理理念尚未建立;“重技术轻人文”的护理理念仍然是影响护理伦理践行的主要因素。临床护理人员普遍有接受有关护理伦理知识和技能培训的需求和愿望。

     

“现代性”视域下的社会心理服务——基于齐美尔的理论——

社会心理服务受到的广泛关注体现了现代生活中的心理需求。齐美尔的“现代性”哲学理论指出, 理智功能、客观文化取得优势地位、社会关系弱化是“现代性”心性结构的三个主要特征。心理健康服务接纳“感性”,关注个体的“完整性”和重视人与人之间的关系,能够帮助现代人避免被技术、商品、劳动淹没,从而缓解现代社会生活引发的焦虑。同时,心理健康服务又必然受到现代社会的影响,故其所展现出的“批判性”又是有限的。

     

人工智能在医学教育领域的应用研究——基于CiteSpace的文献共词分析

人工智能及大数据已经成为包括医学教育在内的各研究领域的热点问题。为了阐明人工智能在医学教育中的发展趋势,利用CiteSpace软件分析2013—2022年Web of Science核心合集文献270篇。从发文量、国家和地区、研究机构、作者、发表杂志、引文情况、关键词及发展趋势等方面进行综合分析得出研究结论：从2018年开始相关论文呈明显增长趋势,Mayo Clinic（梅奥诊所）成为全球发文量最多的研究机构;Friedman等形成了较为完整的研究团体;JAMA成为最高被引杂志;近年医学教育的人工智能应用研究热点问题主要集中在医学影像及虚拟手术等方面。

     

预防还是增强？——人类增强与预防医学之辨析

基因编辑婴儿事件暗示了预防医学和人类增强之间存在某些联系。预防医学以相对明确的潜在疾病为对象,通过增强人体抵抗疾病的能力从而减少或避免由疾病产生的既得利益损失。人类增强以人类的某种特性为对象,通过增强这些特性或保持这些特性的最佳状态,从而获得额外收益或避免既得利益的损失。在“对象−方法−目的”模型下,预防医学和人类增强表现得极为相似,并且在诉求、技术、概念和形而上学方面的相互交错也进一步模糊了两者之间的界线。然而,人类增强完全市场化分配制度及其对公平的固有破坏性是它与预防医学之间的一个根本区别。

     

精神分裂症患者的疾病表达与身份困境——一项基于知乎的实证研究

基于知乎的25起自述文本,研究精神分裂症患者的疾病表达,探究患者病程对叙事类型产生的影响,剖析患者面临的身份困境。研究发现,接受治疗的患者偏向于康复叙事,未治疗的患者偏向于混乱叙事和探寻叙事;同时,精神分裂症患者面临本我、自我与超我相互冲突的身份困境。未来可以在传播层面针对性加强精神疾病类的科普教育以促进患者就医;在叙事层面挖掘以病患作为主体传播模式的潜力、深化叙事疗法中的共情体验以辅助患者建构身份。

     

医学史研究的守正创新和与时俱进——评《张慰丰医学史文集》

医学史是研究医学发展过程及其规律的科学。《张慰丰医学史文集》系统丰富地呈现了医史学家张慰丰教授的医史学思精华、学术探索历程和个人治学风采。通过分析张慰丰教授的研究成果,结合新时期医学教育和医学发展要求,提出医史研究需夯实基础,理清学科发展史和学术谱系,加强专业人才培养,促进多平台合作交流,不断探索新理论、新方法,从疾病史、社会史、文化史、思想史等角度,审思前沿热点问题,关注医学博物馆研究、医学史相关思想政治课程教学与实践,与时俱进地推动医学史学科建设与发展。

     

以社区为基础的老年人长期照护体系构建

综合近年对杭州市老年人、老年人照护及照护机构、照护队伍的现状研究,分析老年人长期照护存在的主要问题,提出以社区为基础的老年人长期照护构建的主要内涵,为相关制度建设提供依据。并提出了促进社区日间照料中心、以社区卫生服务中心为依托的社区老年护理院及其他老年护理机构的规范建设;加强服务队伍培训;设立转介制度和转介标准,建立老年人长期照护转介体系;建立评估标准、第三方评估运作方式及公众监督机制,逐步完善评估制度;加强风险管理;规范社区长期照护体系运作。     

上海社区医院安宁疗护团队的工作困境质性研究

基于角色理论,通过访谈四家上海社区卫生服务中心的安宁疗护团队,研究探索安宁疗护医生、护士、社工及护工的工作困境。经访谈发现,团队面临的工作困境主要来自于死亡与病痛的压力(角色超荷)、专业技能无法满足实际需求(角色模糊)、医患双方对安宁疗护的预期差异(角色冲突)。上述结果拓展了角色理论在安宁疗护领域的应用,显示了其局限性。研究呼吁尽快完善安宁疗护相关法律保障,以保护患者知情权与安宁疗护团队成员的基本权益。

     

Christian Life Emphasis in the Retirement Community: A Koinonia of Spiritual Awareness

ABSTRACT

Retirement Community living sponsored by groups of churches or related, in any direct sense, to a purpose that is called Christian, should, in very specific ways, demonstrate that faith in Christ is an integral part of resident life.

An organization, within the retirement community of Holly Hall in Houston, Texas, seeks to fulfill that requirement by a deliberate commitment to what is called Christian Life Emphasis. It involves a variety of bonding rituals and a ministry of resident to resident that enables spiritual awareness to permeate the continuum of care.     

Prevalence of Cognitively Intact Individuals Residing in Extended Care Nursing Facilities

There appears to be a relative absence of studies that have examined the prevalence of cognitively intact individuals who reside in extended care facilities. Prevalence data were collected on 296 persons who resided in 3 extended care nursing facilities in Central Virginia. Cognitive intactness was evaluated via the Minimum Data Set Cognitive Performance Scale (CPS) and an author-generated survey (i.e., Cognitively Intact Survey [CI Survey]) of select nursing staff members at each facility. The Mini-Mental State Examination (MMSE) was utilized to examine the accuracy of the two measures in identifying cognitive intactness. Findings indicated that prevalence rates of cognitively intact residents varied as a function of the measures utilized to assess intactness. Specifically, a significantly greater proportion of the total sample of residents was judged to be cognitively intact via the CI Survey (34.12%) as compared to the CPS (26.01%). The level of interjudge agreement between the two measures was found to be moderately high (K = 0.68). When the MMSE was employed to verify individuals' levels of intactness, the percentages of residents predicted to actually be cognitively intact were somewhat lower for each measure. Specifically, based on the data obtained via the CI Survey, 22.75% of the total sample were predicted to actually be cognitively intact, whereas 17.85% of the sample were predicted to be intact based on the CPS results. Findings are discussed in light of factors that may have contributed to the differential prevalence rates of cognitively intact individuals obtained across the measures utilized in this study. Concerns regarding the utilization of the MMSE as a criterion measure of cognitive intactness in persons residing in extended care nursing facilities are provided, along with data on the living environments/roommate statuses of those residents judged to be intact via the CI Survey. Implications for the design of future extended care nursing units, as well as future research, are also included.     

Recognition and Social Justice: A Roman Catholic View of Christian Bioethics of Long-Term Care and Community Service

Contemporary Christian ethics encounters the challenge to communicategenuinely Christian normative orientations within the scientificdebate in such a way as to render these orientations comprehensible,and to maintain or enhance their plausibility even for non-Christians.This essay, therefore, proceeds from a biblical motif, takesup certain themes from the Christian tradition (in particularthe idea of social justice), and connects both with a compellingcontemporary approach to ethics by secular moral philosophy,i.e. with Axel Honneth's reception of Hegel, as based on Hegel'stheory of recognition. As a first step, elements of an ethicsof recognition are developed on the basis of an anthropologicalrecourse to the conditions of intersubjective encounters. Theseconditions are then brought to bear on the idea of social justice,as developed in the social-Catholic tradition, and as systematicallyexplored in the Pastoral Letter of the United States Conferenceof Catholic Bishops, Economic Justice For All (1986). Proceedingfrom this basis, aspects of a Christian ethics of communityservice with regard to long-term care can be defined.     

Incongruent Perceptions Among Nurses and Patients: A Qualitative Study of Patient's Dignity in Iran

Dignity is the most fundamental right of every human being, patients in particular. Despite being a fairly disputed concept, dignity is a multidimensional issue, the interpretation of which is affected by a multitude of factors. Semistructured interviews and observation data from 35 patients, their companions, and nurses were performed to highlight their views with regard to patients’ dignity in health care centers. Although findings reveal that nearly all patients felt that their dignity had been violated, there is a considerable difference between participants’ viewpoints of dignity. Interactions among participants can increase their awareness of dignity and may lead to its maintenance.     

The Nature of Generalized Anxiety in Older Primary Care Patients: Preliminary Findings

Clinical features of older primary care patients with GAD (PC-GAD; n = 22) were examined relative to older patients with GAD recruited for two academic clinical trials (M. A. Stanley, J. G. Beck, et al., 2003; J. L. Wetherell, M. Gatz, & M. G, Craske, 2003) and to a sample of older primary care patients without psychiatric diagnoses (No Dx; n = 10). Comparisons revealed similar levels of worry, anxiety, depressive symptoms, quality of life, and functional status between the PC-GAD subsample and patients recruited for academic trials, although primary care patients were older, less well educated, and more ethnically diverse. The PC-GAD subgroup, however, reported greater symptom severity, reduced quality of life, and poorer perceived general health, mental health, and vitality than the No Dx subgroup (² = .23–.43). Service utilization was not different between PC-GAD and No Dx subgroups, with the exception of psychotropic medication use. The Penn State Worry Questionnaire (PSWQ) and an abbreviated version of this measure may be useful for identifying late-life GAD in primary care. Cutoff scores of 50 and 22 on the full and abbreviated versions of the PSWQ, respectively, demonstrated excellent specificity, sensitivity, and positive predictive value. Negative predictive value was less impressive, probably as a result of high base rates for GAD in this sample.     

Community Participation Needs of Families With Children With Behavioral Disorders: A Systems of Care Approach

The purpose of the current study was to convey findings regarding the community participation needs of families who have children with behavioral disorders. The changing focus of community-based service provision to the systems of care approach for children with mental health needs requires family input to identify and better address their needs. This study identified characteristics of community participation in families of children with mental health needs through a survey, using mixed methods design and purposeful sampling. Evolved themes supported challenges for policymakers to make changes in professional, school, and community supports. Occupational therapists have a strong skill set to offer these families and must work collaboratively with family organizations, provide support for successful engagement in desired social activities, and build adaptive behaviors in children with mental health needs.     

Research Agenda to Facilitate Community Participation In HIV Vaccine Research: A Participatory Approach

This article reports on a participatory process to generating a research agenda to guide research on community participation in HIV vaccine research. Community members representing stakeholder parties involved in the HIV vaccine research enterprise were invited to participate in the process. Fourty-five participants participated in the process and we used interactive techniques to stimulate discussion and interaction between community members at different levels of the HIV vaccine research enterprise. Through the process we generated a locally grounded research agenda to guide research on community participation in HIV vaccine research that originates out of the experiences, challenges and concerns of community members.     

Mental Health Problems,Recovery, and the Impact of Green Care Services: A Qualitative,Participant-Focused Approach

This study aimed at gaining knowledge of users' experience of green care services (interventions using nature to improve health) for people with mental health or drug problems. Data were obtained from interviews with 20 participants in green care services and were analyzed qualitatively. Findings revealed that work in a social context close to nature and work with animals increased mastery and meaningfulness. Participation resulted in personal changes, new practical skills, improved social networks, and feelings of well-being. There appears to be powerful potential in using green care services as a recovery tool for people with mental health or drug-related problems.