微创医学--一个新的医学理论体系

在新的世纪里,为了回归医学本源、适应人类社会发展的需要,有必要探求一种新的医学智慧、建立一个新的医学系统.从历史唯物主义和辩证法的现点出发,在深入研究"微创"概念及内涵的发展演变、二十一世纪医学发展的未来趋势和社会对医学-医院最大要求的基础上,作者等以生物心理社会医学模式为基础,在学界提出了"微创医学"的概念、建立了"微创医学体系"并正在进行着微创医学的具体实践--在微创医学理论指导下建设"微创医院".本文详细描述了微创医学体系:基本理论系统和临床架构系统.创立微创医学体系的根本目的在于在医学上、在医院里达到真正实现"以人为本"的理念.     

"人文解剖学"视野中的医学创伤与医疗干预

医学发展至今,一直是"征服疾病"的干预手段,这种干预有着扩展和泛化的趋势,逐渐由修复向替代发展.随着医学人文思想的逐步觉醒,"人文解剖学"的引入,人们开始对医疗干预,尤其是创伤干预进行了反思.微创医学的兴起,从三个方面给予这种过度干预以新的思考.由此而得到的启示是,医学需要两盏灯引路,一盏是职业和技术的灯,一盏是人文主义的灯.     

从医学人文角度看微创医疗中的危险因素

微创医疗是现代医学的一项新技术和新兴理念,由于具有创伤小、恢复快等特点而风靡全球,人们迷恋于微创技术的绝对化作用,关注的焦点也更多地是在微创技术自身的创新与改进,而对微创技术带给患者及麻醉的附加伤害和危险却很少问津,当今微创医疗技术发展的基础在于直面问题和解决问题,用技术自身发展解决技术缺陷问题,用人文理念改善和解决医学的人性问题。成功的微创技术是多学科协助的结果,务必认清医学的仁学特性,坚持微创发展的人性化方向,科学规避微创中的危险因素,为微创技术的可持续发展奠定基础。     

以腹腔镜手术为代表的微创技术在泌尿外科的应用

随着科学技术的进步,微创医学正在形成和发展.泌尿外科是微创医学最活跃的专业之一.腹腔镜手术已被公认是现代微创外科技术的代表,正逐渐走向成熟,趋于标准化和规范化.目前多种泌尿外科腹腔镜手术已成为首选治疗方法.近年出现的机器人手术、计算机辅助外科与虚拟现实技术被认为是在腹腔镜手术基础上产生的第3代手术,正在走向现实.我们要对微创泌尿外科有一个再认识,更加准确把握微创泌尿外科的适应证,促进微创泌尿外科更加健康地发展.     

北京微创医院建设的初步实践--从微创医学理论到具体实践

创建微创医院是发展我国微创医学的首要和必需条件.微创医院是一类以微创理念为指导、以微创医学体系为主导、以整合的微创技术为特色、以"医疗中心"为基本临床结构系统的现代化、数字化的综合性医院.建设微创医院的目的在于验证微创医学理论体系,探索新的医学智慧.     

医学人性的复归:微创医学与全人医疗

微创医学是现代医学发展进程中的一种紧急转向,是当代医学治疗思想的一次重要调整,同时也是古代自然疗法的复归与提升.从微创外科到微创医学,到微创医学体系,到全人医疗,是医学人性复归之路.     

微创医疗的决策思考与实践——兼论微创手术最佳适应证的选择

微创医学是一个新的医学理论体系.在具体临床医疗决策过程中如何运用微创医学理论是一个必须解决的理论和实践问题.微创医学人文观、科学观、技术观和社会观是医疗微创化决策思想的主要内容,在实践中具有重要的指导意义,尤其是对于微创手术最佳适应证的选择.     

理性看待微创外科

所谓"微创",乃是传统外科发展的伸延和提升.微创不等于无创,微创需要科学的决策,同时微创要运用循证医学.微创具有广阔的前景,但它的治疗之路依然很长.它需要进一步的完善.目前,还不是丰收的季节.     

部分腮腺切除术的微创理念和人文思考

传统的腮腺肿瘤切除术术后面部瘢痕较明显,美观效果较差,且容易造成面瘫等并发症,极大地影响患者的社交活动,甚至造成严重的心理创伤.部分腮腺切除术以病理学研究为基础,采用微创术式,在保证肿瘤完整切除的基础上缩小了手术范围,减轻了术后的颜面部畸形,降低了面神经损伤的几率,并且未增加肿瘤的复发率.部分腮腺切除术重视患者身心统一,在身体和心理上同时实现微创,是医疗技术的进步,更是人文精神的延续,是医学技术与医学人文相结合在口腔颌面外科的成功实践.     

微创医学中的介入性超声

超声检查具有实时、动态、灵活、方便等优点,在临床上有重要作用.介入性超声是在超声显像的基础上,为进一步满足临床诊断和治疗的需要而发展起来的一门新技术,在微创医学体系中占有非常重要的地位,但只有与其它微创技术联合应用才更有活力和生机.     

降低医疗的二次伤害是医学人性化发展方向

医学是一种人性化的表达,然而,医学手段的伤害性特征也是现代医学本身无法回避的一个缺陷,忽视对医学技术本身的伤害性因素的认识,是当下医学人文衰退的一个重要原因,也是构建人性化医疗的一道障碍,面对越来越多的对医学伤害性的质疑,医学应该进行自我剖析,撕开医学手段的非人性化面纱,务必直面问题和解决问题,用医学的人性化关怀弥补医学手段的伤害性缺陷,并以医学技术本身的发展,促进医学向无伤害的人性化方向发展,这是现代医学发展的终极目标。     

A one-way random effects model for trimmed means

The random effects ANOVA model plays an important role in many psychological studies, but the usual model suffers from at least two serious problems. The first is that even under normality, violating the assumption of equal variances can have serious consequences in terms of Type I errors or significance levels, and it can affect power as well. The second and perhaps more serious concern is that even slight departures from normality can result in a substantial loss of power when testing hypotheses. Jeyaratnam and Othman (1985) proposed a method for handling unequal variances, under the assumption of normality, but no results were given on how their procedure performs when distributions are nonnormal. A secondary goal in this paper is to address this issue via simulations. As will be seen, problems arise with both Type I errors and power. Another secondary goal is to provide new simulation results on the Rust-Fligner modification of the Kruskal-Wallis test. The primary goal is to propose a generalization of the usual random effects model based on trimmed means. The resulting test of no differences among J randomly sampled groups has certain advantages in terms of Type I errors, and it can yield substantial gains in power when distributions have heavy tails and outliers. This last feature is very important in applied work because recent investigations indicate that heavy-tailed distributions are common. Included is a suggestion for a heteroscedastic Winsorized analog of the usual intraclass correlation coefficient.     

Priming against your will: How accessible alternatives affect goal pursuit

Four studies examined how diverse aspects of goal pursuit are influenced by the accessibility of alternative goals. It was consistently found that such an accessibility often affects the resources allocated to a focal goal, influencing commitment, progress, and the development of effective means, as well as one's emotional reponses to positive and negative feedback about one's striving efforts. Moreover, the direction of these influences was found to depend on how the alternative goals relate to the focal pursuit. Alternatives unrelated to the focal goal pull resources away from it, whereas alternatives facilitatively related to a focal goal draw resources toward it.     

药物性肝损伤的临床处置策略

本文讨论了药物性肝损伤治疗的相关临床问题,概括出以下几点：（1）可预知性与不可预知性肝毒性药物的临床处置方法,强调治疗的关键是停止肝毒性药物的使用以及停药的具体指征;（2）支持治疗不应被忽视,以及如何实施;（3）解毒药物的概念和种类;（4）保肝药物应用中存在的问题,主要是不按药理机理选择和多重用药,介绍了保肝药的不同机理和代表药物,阐述不要多种保肝药联合的基本原则;（5）根据肝损伤临床类型选择不同的治疗方案,肝细胞损伤以保肝药物治疗为主,胆汁淤积以利胆治疗为主,对重症肝损伤者应人工肝支持治疗,必要时进行肝移植.     

Evolution and medicine: the long reach of "Dr. Darwin"

In this review we consider the new science of Darwinian medicine. While it has often been said that evolutionary theory is the glue that holds the disparate branches of biological inquiry together and gives them direction and purpose, the links to biomedical inquiry have only recently been articulated in a coherent manner. Our aim in this review is to make clear first of all, how evolutionary theory is relevant to medicine; and secondly, how the biomedical sciences have enriched our understanding of evolutionary processes. We will conclude our review with some observations of the philosophical significance of this interplay between evolutionary theory and the biomedical sciences.     

乳腺癌治疗的现代医学目的

乳腺癌的治疗方法的变化,恰好说明了传统医学目的与现代医学目的不是对立或相互排斥,而是辩证的统一.现代医学目的是以传统医学目的为基础和前提的,是继承和发展,是重新审视传统医学目的后提出来的.     

How Christian ethics became medical ethics: the case of Paul Ramsey.

Over the last century Christian ethics has moved from an attempt to Christianize the social order to a quandary over whether being Christian unduly biases how medical ethics is done. This movement can be viewed as the internal development of protestant liberalism to its logical conclusion, and Paul Ramsey can be taken as one of the last great representatives of that tradition. By reducing the Christian message to the 'ethical upshot' of neighbour love, Ramsey did not have the resources to show how Christian practice might make a difference for understanding or forming the practice of medicine. Instead, medicine became the practice that exemplified the moral commitments of Christian civilization, and the goal of the ethicist was to identify the values that were constitutive of medicine. Ramsey thus prepared the way for the Christian ethicist to become a medical ethicist with a difference, and the difference simply involved vague theological presumptions that do no serious intellectual work other than explaining, perhaps, the motivations of the ethicist.     

Inverting the Simon effect by intention

Summary The Simon effect indicates that choice reactions can be performed more quickly if the response corresponds spatially to the stimulus - even when stimulus location is irrelevant to the task. Two experiments tested an intentional approach to the Simon effect that assigns a critical role to the cognitively represented action goal (i. e., the intended action effect). It was assumed that the direction of the Simon effect depends on stimulus-goal correspondence, that is, that responses are faster with spatial correspondence of stimulus and intended action effect. Experiment 1 confirmed that the direction of the Simon effect was determined by spatial correspondence of stimulus and intended action effect, the latter having been manipulated by different instructions. Experiment 2 indicated that effects of correspondences unrelated to the action goal (i. e., stimulus to hand location or to anatomical mapping of the hand), contributed additively to the resulting Simon effect. It is discussed how current approaches to the Simon effect can be elaborated to account for these results.     

The Effects of Varying Goal Difficulty Operationalizations on Goal Setting Outcomes and Processes

The three studies reported here investigated the effect of operationalization of goal difficulty on the relationship between goal difficulty and performance. Subjects were assigned goals (easy, moderately difficult, or very difficult) under either an absolute goal level or performance improvement condition. Results indicated that the goal difficulty interacted with operationalization in affecting performance. Specifically, there was a linear relationship between goal difficulty and performance when goals were operationalized in terms of absolute level, but an inverted U-relationship between these two variables when goals were operationalized in terms of performance improvement. This interaction held up despite controlling for normative goal difficulty, performance improvement difficulty and absolute goal level difficulty. The effects of operationalization seemed to be attributable to differences in self-set goal levels, particularly among high ability persons. Taken as a whole, these studies indicate that how assigned goals are derived and how they are communicated to subjects affects goal setting outcomes.     

What time reversal invariance is and why it matters

David Albert's Time and Chance (2000) provides a fresh and interesting perspective on the problem of the direction of time. Unfortunately, the book opens with a highly non-standard exposition of time reversal invariance that distorts the subsequent discussion. The present article not only has the remedial goal of setting the record straight about the meaning of time reversal invariance, but it also aims to show how the niceties of this symmetry concept matter to the problem of the direction of time and to related foundation issues in physics.