尿毒症的无效治疗与经济伦理学问题

现代医学治疗的有效与无效的急论越来越引起社会关注。关于尿毒症无效治疗的医患关系、资源分配及道德价值的讨论是有积极意义的;结合具体病案,建立尿毒症无效治疗的评价标准,其对临床实践具有指导价值。无效治疗、前死状态以及血液透析疗法均有经济伦理学争论。     

3例ICU患者放弃治疗医患抉择异议的伦理思考

ICU病房患者放弃治疗一直是医患双方争论的焦点,如何正确地对放弃治疗患者做出抉择显得格外重要。以3例ICU患者放弃治疗的实际案例为例,论述医患双方抉择的异议,进而深入剖析案例引发的伦理思考。从医务人员的角度探讨案例体现的过度医疗和无效医疗问题、终止治疗和放弃治疗问题以及对生命质量及价值的权衡,并提出强化疗效伦理意识、合理取舍放弃治疗时机、树立正确的生命观、增强对放弃治疗患者的临终关怀等解决对策,以期达到对ICU病房中危重患者救治更符合伦理要求的目的,为医患双方对ICU患者放弃治疗抉择提供伦理参考。     

关于我国医患会话研究的思考

医患会话分析是一种尊重语言事实的社会学实证研究方法.我国研究者主要从医患会话的语言结构组合特点和基本特征;医患合作模式、特点和原则以及医患会话信息传递方式等方面进行了分析.目前研究中存在语料的覆盖面、典型性不够,分析语言现象与本质的逻辑不严密,语料属性判断标准不统一,研究目标不明确等主要问题.     

医患诚信问题解析

医患诚信是现代中国医患关系中的一个重要问题。但当前学界在对医患关系问题进行讨论时,缺少对该问题的深入而细致的分析。指出当前对中国医患诚信问题的研究存在着四个方面的问题。其中,医患诚信危机是理解医患关系现状的关键点,剖析中国医患关系问题的着力点,重构医患诚信更是扭转医患关系紧张的切入点。     

基于场景记忆的参照系整合过程中的物体方位判断

以绝对方位中的物体方位判断为实验任务,并按照以往研究把判断过程进行分解为获取目标位置信息、获取前行方向信息和判断目标物体相对于参照物体的方位信息,旨在考察不同信息获取过程下的目标位置和前行方向如何影响基于场景记忆的参照系整合过程中的绝对方位判断。实验1的判断任务同时包括这三个过程;实验2和实验3中的判断任务分别独立于路径描述（即定位后判断,先获知目标位置信息,再进行方位判断）和自身定向（即定向后判断,先获取前行方向信息,再进行方位判断）。每个任务均为目标位置（R0o－前、R45o－左前/右前、R90o－左/右、R135o－左后/右后, R180o－后）×前行方向（北、东南西、斜方向）的组内设计、因变量为正确率和判断时间为主,共有60名大学生被试（男女各半）参与实验。发现：朝北优势效应只在实验1中明显;三个实验任务中均存在正方向－左右位置优势效应、以及0o和180o位置优势效应;目标位置对物体方位判断的影响程度要大于前行方向对判断的影响程度。结合以往的研究来看,场景记忆上的判断比视觉媒介上的同类判断受目标位置影响的程度要大,其他影响模式比较一致。从判断的信息获取过程上对结果进行了讨论,这有助于理解绝对方位判断的认知结构     

医患诚信问题解析

医患诚信是现代中国医患关系中的一个重要问题.但当前学界在对医患关系问题进行讨论时,缺少对该问题的深入而细致的分析.指出当前对中国医患诚信问题的研究存在着四个方面的问题.其中,医患诚信危机是理解医患关系现状的关键点,剖析中国医患关系问题的着力点,重构医患诚信更是扭转医患关系紧张的切入点.     

美国院前急救医患沟通＂十条金律＂解析

医患沟通的能力和技巧是院前急救人员必备的重要素养之一,与院前急救服务的效率和质量密切相关.在美国急救医疗服务体系中,普遍遵循医患沟通＂十条金律＂,包括：（1）保持职业化状态;（2）始终保持与患者目光接触;（3）给予患者恰当的称呼;（4）使用患者听得懂的语言;（5）保持恰当的语速、语调和语气;（6）与他人谈论患者病情务必谨慎;（7）当心自身的肢体语言;（8）给患者留下回答问题或反应的时间;（9）告诉患者病情真相;（10）注重与特殊群体的沟通.本文简要解析了＂十条金律＂的内涵与意义,对我国院前急救人员或有借鉴意义.     

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.     

重要他人情境对青少年意图判断诺布效应的影响*

设置了母亲、朋友、老师三类重要他人,副作用结果为积极和消极两种性质的实验故事共六个,选取311名中学生阅读故事并回答问题,以此探讨青少年诺布效应的特点及其与心理状态理解的关系。结果表明：（1）青少年在对不同重要他人的积极副作用情境进行意图判断时,表现出典型的诺布效应,但在对不同重要他人的消极副作用情境进行意图判断时,没有表现出诺布效应;（2）母亲、朋友和老师这三类重要他人对于青少年意图判断的影响没有显著差异;（3）初中生和高中生、男生和女生的意图判断没有显著差异;（4）青少年认为,由消极副作用引起的被行为者的情绪以负性情绪为主,而行为者的情绪则以正性情绪为主。本研究的结论是：青少年在进行意图判断时仅出现了不完全的诺布效应。     

无效治疗--医者的困扰

关于无效治疗的争论越来越受到社会各方面的重视,但由于各自的利益和出发点不同,社会各方对无效治疗的观察角度和侧重点不同。从医务工作者的角度,就无效治疗的概念、判定及无效治疗实施过程中的利益冲突和解决对策进行讨论。     

Patient — heal thyself

(This is a story of a courageous woman who refused to accept the fact that her medical disease was incurable or irreversible. This paper was written about 18 months ago. Since then, the author has continued her struggles, her risk-taking searches, and her hope. -Ed.)     

Beliefs about surgery: Development and validation of an instrument to assess cognitive representations about surgery,in the context of a chronic illness

Objectives: Within a trial of medical and surgical treatments for gastro-esophageal reflux disease (GORD), involving randomised arms and preference arms, we tested the applicability of the Beliefs about Medicines Questionnaire (BMQ) and developed and tested the validity of a new Beliefs about Surgery Questionnaire (BSQ). Methods: Patients with GORD (N = 43) were interviewed to elicit their beliefs about medical and surgical treatments. These contributed to the development of BSQ items. The BMQ and BSQ were completed by trial participants at baseline (randomised trial: N = 325; preference trial: N = 414). Factor analysis and discriminant function analysis were used to assess validity. Results: Principal components analysis (PCA) largely replicated the four-factor BMQ structure. PCA of the combined BMQ/BSQ yielded six factors explaining 54.5% variance. BSQ items loaded onto distinct factors, demonstrating divergence from BMQ. As predicted, BMQ/BSQ scores enabled correct classification of 78.5% of participants to medication and surgery groups in the preference trial (χ²(6) = 205.9, p < 0.001) but only 54.5% (no better than chance) in the randomised trial (χ²(6) = 9.4, p = 0.154). Conclusions: The BSQ is a valid measure of perceptions about surgical treatments for GORD. With the BMQ, it provides information that may guide patients’ choices about treatment. This measure may be applicable to other conditions.     

The hazards of writing or disclosing information in psychiatry

The health care professional must be aware of the potential hazards in writing or disclosing information about a patient or a non-patient. Two important interests are pitted against each other: dissemination of scientific information versus confidentiality. Presented is a discussion of the legal and ethical issues involved in (1) writing an article or book about a patient, (2) writing about a research subject, (3) writing about a subject of a forensic examination on behalf of the court or attorney, and (4) writing in a medical record.     

Context Sensitivity and Balancing in Indian Organizational Behaviour

This paper attempts to explain Indian organizational behaviour with the help of two interrelated concepts: context sensitivity and balancing. Context sensitivity pertains to beliefs about person (patra), time (kal), and ecological (desh) components of the environment. Balancing is a behavioural disposition to avoid extremes and to integrate or accommodate diverse considerations. Traditional systems such as Hindu religion, caste as a form of social stratification, and agricultural mode of production have interacted with foreign invasions and alien rules to give rise to several sociocultural characteristics: (1) group embeddedness and hierarchy while relating to people (patra), (2) uncertainty about future and the resultant short-term perspective while relating to time (kal), and (3) scarcity of resources, deficient infrastructural facilities, and poverty syndrome while relating to ecology (desh). Rapid industrialization and the transplant of Western technology and work forms in the last three decades have added individualistic values and Western management practices. While responding to the three components of the environment, people exhibit both a primary expresive mode that is traditional in nature and a secondary expressive mode that is acquired as a result of the transplantation of the Western management system onto a traditional core. Superior-subordinate relationships, work behaviour, and management practices reflect both the primary and secondary modes in varying degrees.     

A qualitative analysis of attitudes to face transplants: Contrasting views of the general public and medical professionals

While there has been a considerable criticism and debate about face transplantation from ethicists, surgeons and psychologists, little is known about the attitudes of medical professionals and the general public whose support will be necessary if face transplants are to be accepted. This study therefore conducted in-depth, semi-structured interviews with medical professionals (8) and the general public (8) to explore their understanding of and attitudes to face transplants. A thematic analysis was used to analyse these data. Five overarching themes were identified including agreement in principal, caveats and conditions, medical and technical difficulties, function and appearance, and the significance of the human face. The analysis revealed overwhelming support in principle for face transplants, but with important caveats and conditions. Both groups shared clear representations of deserving and undeserving candidates, and concerns about psychological adjustment. The general public sample demonstrated little understanding of medical implications or the consequences of a failed graft, which did concern the medical professionals. Neither group showed a clear understanding of the psychological or social factors required to predict best outcomes and identify suitable candidates. Analyses revealed a stereotypical belief from both groups that the life of a severely disfigured recipient is intolerable without this operation.     

工作不安全感的研究现状与展望

工作不安全感反映了一种雇员对工作或工作重要特性受到威胁时的感知和担忧。从上世纪80年代以来,它已逐步成为西方组织行为及职业心理健康研究领域中的一个重要构念。文章从5种视角厘清工作不安全感内涵及研究中存在的混淆之处,对其测量工具、研究取向进行介绍,并对有关其前因、后果和调节变量的实证研究成果进行系统性的总结,在此基础上指出未来研究的方向：（1）亟待开发统一的测量工具;（2）在区分组织情境的条件下开展更细化的研究;（3）对前因及后果的细致探索;（4）加强对调节变量的研究;（5）纵向研究的需要;（6）跨文化比较研究。     

A qualitative analysis of attitudes to face transplants: contrasting views of the general public and medical professionals

While there has been a considerable criticism and debate about face transplantation from ethicists, surgeons and psychologists, little is known about the attitudes of medical professionals and the general public whose support will be necessary if face transplants are to be accepted. This study therefore conducted in-depth, semi-structured interviews with medical professionals (8) and the general public (8) to explore their understanding of and attitudes to face transplants. A thematic analysis was used to analyse these data. Five overarching themes were identified including agreement in principal, caveats and conditions, medical and technical difficulties, function and appearance, and the significance of the human face. The analysis revealed overwhelming support in principle for face transplants, but with important caveats and conditions. Both groups shared clear representations of deserving and undeserving candidates, and concerns about psychological adjustment. The general public sample demonstrated little understanding of medical implications or the consequences of a failed graft, which did concern the medical professionals. Neither group showed a clear understanding of the psychological or social factors required to predict best outcomes and identify suitable candidates. Analyses revealed a stereotypical belief from both groups that the life of a severely disfigured recipient is intolerable without this operation.     

The framing heuristic influences judgements about younger and older adults' decision to refuse medical treatment

Three-hundred and one young adults evaluated medical dilemmas in which a patient (1) was portrayed as either 40 or 70 years old, (2) decided to either refuse or consent to a risky treatment for a serious medical disorder, and (3) received either positively or negatively framed information about the potential effectiveness of a proposed medical treatment. Participants' evaluations of the patients' decisions reflected the implementation of a framing heuristic and an age heuristic. The framing heuristic influenced participants' judgements of patients who refused the proposed treatment. Specifically, information which was positively framed resulted in risk-avoiding judgements, while information which was negatively framed resulted in risk-taking judgements. The age heuristic predisposed participants to recommend that 40 year old patients, more so than 70-year-old patients, opt for high-risk medical treatments that could potentially add a large number of years to their lives.     

流动儿童社会适应的研究:现状、问题及解决办法

参照国外关于移民儿童社会适应研究的现状,对国内流动儿童社会适应的研究现状进行了回顾,指出了国内该研究领域存在的几个不足:(1)评估指标不全面;(2)评估存在缺陷取向;(3)忽视个体差异的问题;(4)研究设计与社会适应的过程理论相背离;(5)教育安置方式对流动儿童社会适应的影响未得到应有的重视。最后提出了解决以上问题的办法。     

Comforting when we cannot heal: the ethics of palliative sedation

This essay considers whether palliative sedation is or is not appropriate medical care. This requires one to consider (a) whether, in addition to the good of health, relief of suffering is also a proper end of medicine; (b) whether unconsciousness can ever be a good for a human being; and (c) how double-effect reasoning can help us think about difficult cases. The author concludes that palliative sedation may be proper medical care, but only in a limited range of cases.