腰腿痛患者现病史的客观采集及其评价

腰腿痛患者的现病史采集比较困难,临床上经常引发混乱,甚至会被忽略.作者根据临床经验总结了一套相时系统和客观的分析思路.借此启发和提示临床医生临诊分析的主观能动性.作者还通过对现病史采集在医学发展史上的地位变化的回顾,提出了现代临床医学对患者症状特征进行归纳分析的重要性.     

骨科急诊患者诊治中的决策问题

在骨科急诊患者的诊治过程中,骨科医师应该区分病情的轻重缓急,抓住重点进行处理。采集和分析临床资料时,应把病史、理学检查结果与检验及影象检查所见结合起来。这样才能作出准确的诊断。在诊断或/和治疗中选定任何一项措施,首先要从病人的情况出发,应尽可能减轻患者的经济负担。总之,为了提高临床决策的效率和准确性,减少或避免各种失误,需要建立起一套合理的临床思维方法和科学的处理程序。     

骨科急诊患者诊治中的决策问题

在骨科急诊患者的诊治过程中,骨科医师应该区分病情的轻重缓急,抓住重点进行处理.采集和分析临床资料时,应把病史、理学检查结果与检验及影象检查所见结合起来.这样才能作出准确的诊断.在诊断或/和治疗中选定任何一项措施,首先要从病人的情况出发,应尽可能减轻患者的经济负担.总之,为了提高临床决策的效率和准确性,减少或避免各种失误,需要建立起一套合理的临床思维方法和科学的处理程序.     

病史采集和体格检查医学行为的人文思考

医务人员的言行都体现了一种职业精神,其医学行为在病患眼里是希望、责任、义务、信任、公正和平等以及等等。病史采集和体格检查是医生的基本功,而正是这项基本技能却随着临床检查仪器和设备的不断更新,正被越来越多的医生所轻视,“望、闻、问、切”正逐渐成为医学历史的痕迹。病史采集和体格检查既体现了一位医生的医疗技能,也蕴含着丰富的人文哲理,是医患相互信任、配合的出发点和归宿,是医生与患者交流和沟通的极其重要行之有效的手段,也是疾病诊治的基本条件和必备元素。     

临床方法依然是神经内科医师最重要的诊断法宝

通过7例疑难、危重患者的诊治过程说明临床方法的重要性,在神经科疾病研究中尤为突出。忽视细致的病史采集和体查,常导致了诊疗的失误;面对种目繁多的检查,更需要以临床方法选择之;临床逻辑思维能力非常重要,正确的临床思维出新知。在实验室检查方法越来越多的今天,临床方法是神经内科医师最重要、方便、快捷、有效的诊断法宝,具有不可替代性。     

病史采集和体格检查医学行为的人文思考

医务人员的言行都体现了一种职业精神,其医学行为在病患眼里是希望、责任、义务、信任、公正和平等以及等等.病史采集和体格检查是医生的基本功,而正是这项基本技能却随着临床检查仪器和设备的不断更新,正被越来越多的医生所轻视,"望、闻、问、切"正逐渐成为医学历史的痕迹.病史采集和体格检查既体现了一位医生的医疗技能,也蕴含着丰富的人文哲理,是医患相互信任、配合的出发点和归宿,是医生与患者交流和沟通的极其重要行之有效的手段,也是疾病诊治的基本条件和必备元素.     

浅谈医生基本功对临床决策的影响

针对医生基本功在医学科学飞速发展的今天有何作用的困惑,阐述了详尽的病史采集、全面而准确的体格检查、合理而科学地选择实验室及辅助检查对临床决策的重要意义。医生只有将基本理论、基本技能、基础知识、道德修养、分析问题、解决问题的能力和水平作为立足之本,才能不断提高临床决策水平。     

浅谈医生基本功对临床决策的影响

针对医生基本功在医学科学飞速发展的今天有何作用的困惑,阐述了详尽的病史采集、全面而准确的体格检查、合理而科学地选择实验室及辅助检查对临床决策的重要意义.医生只有将基本理论、基本技能、基础知识、道德修养、分析问题、解决问题的能力和水平作为立足之本,才能不断提高临床决策水平.     

在内科临床中落实生物心理社会医学模式

社会心理因素与内科疾病的发生、发展和治疗效果关系密切,临床工作中忽视社会心理因素的作用可能导致严重后果。内科医生应积极拓展自身的知识技能,继而把对社会心理因素的重视落在实处,体现在病历中。完整的病史采集又需要加强医患沟通,如此才能真正发现和解决患者的社会心理问题。     

妇产科临床见习教学中融入人文素质教育的探讨

妇产科由于涉及到患者较多的隐私而经常出现患者不愿配合教学的情形,使妇产科临床教学工作及实习质量受到影响.本文采用标准化病人教学来解决这一妇产科临床见习教学中的矛盾,并探讨妇产科临床见习教学中融入人文素质教育的意义.将100名临床见习医学本科生随机分为试验组和对照组(各50人),分别对两组病史采集、实践操作和病历书写能力进行比较,并对所在组教学模式提升人文素质的效果进行评价.结果显示试验组OSCE考核成绩显著高于对照组(P＜0.01),且该组学生的人文素质也得到很大提高(P＜0.01).妇产科临床见习教学中融入人文素质教育,将理论知识与临床实践有机结合,既培养了学生的专业技能,又提高了人文素质.     

Religious Beliefs or Physicians’ Behavior: What Makes a Patient More Prone to Accept a Physician to Address His/Her Spiritual Issues?

The present study aims to understand the relation between religious beliefs, physicians’ behavior and patients’ opinions regarding “Spirituality, religiosity and health (S/R)” issues, and what makes a patient more prone to accept a physician to address his/her spiritual issues. A cross-sectional study was carried out in outpatients from a tertiary hospital, and a path analysis was used to examine the direct and indirect relationships between the variables. For the final analysis, 300 outpatients were evaluated. Most patients would like their doctors to address S/R issues but did not feel comfortable to ask them. In contrast, they reported most doctors have never addressed S/R issues, and they believe doctors are not prepared to address these issues. The path analysis revealed that patients’ previous experiences with their doctors may be as important as their religious/spiritual beliefs in proneness to accept a physician to address his/her spiritual issues.     

Philosophies of Life and Painful Experiences

The article discusses whether the philosophy of the modern era may be traced back to the thought of Martin Luther. This position has been advocated by French political philosopher Reiner Schürmann in his book Broken Hegemonies, on the history of Western thought from a phenomenological point of view. The author finds Schürmann's position remarkable in three respects: (i) It suggests a philosophical influence from Luther which is in accordance with his own criticism of Aristotelian metaphysics; (ii) it makes plausible that there is a transcendental turn at the heart of Luther's approach; but (iii) it nevertheless points out important differences between Kant's autonomy and Luther's heteronomy which have substantial consequences for their anthropology, epistemology, and theory of interpretation. The author finds that Schürmann argues convincingly for his point of view, in spite of some critical objections, and he concludes with a discussion of how such a genealogy may influence the present discussion on self and other in the philosophical debate.     

1. On note taking

In this paper the author explores the theoretical and technical issues relating to taking notes of analytic sessions, using an introspective approach. The paper discusses the lack of a consistent approach to note taking amongst analysts and sets out to demonstrate that systematic note taking can be helpful to the analyst. The author describes his discovery that an initial phase where as much data was recorded as possible did not prove to be reliably helpful in clinical work and initially actively interfered with recall in subsequent sessions. The impact of the nature of the analytic session itself and the focus of the analyst's interest on recall is discussed. The author then describes how he modified his note taking technique to classify information from sessions into four categories which enabled the analyst to select which information to record in notes. The characteristics of memory and its constructive nature are discussed in relation to the problems that arise in making accurate notes of analytic sessions.     

The relevance of the Oedipus myth to fostered and adopted children

The paper makes a conceptual distinction between aggressive phantasies and acts against the object and a destructive form of potentially objectless violence resulting from attacks on the mental capacity for linking terms of –K. In thinking about the issue of the internal states leading to mindless destructiveness, the author suggests that such behaviour may result from active envious attacks on the capacity for linking, but that, in some cases, early trauma may result in a more passive breakdown of the human disposition for creating emotional mental links. The discussion of the clinical history of a destructive latency child who was born at six months of gestational age connects the traumatic beginning of his life with his violent behaviour.     

辅助检查的正确评估和应用之管见

辅助检查是临床诊断的重要手段,正确的认识、合理地选择、恰当地评价辅助检查,能使临床医生在更短的时间、更大的范围、更深的层次上获得关于疾病的更精细的客观资料,为疾病的诊断提供依据。假若不能正确地选择和使用辅助检查,或者不能恰当地评价辅助检查的结果,辅助检查又往往会成为认识疾病本质的障碍,成为误诊的原因之一。     

下腰痛的影像学过度诊断及对策

下腰痛的发病率很高,就诊的患者人次居骨科就诊患者的首位.当前临床上存在下腰痛影像学的"过度检查",原因包括医方的利益驱动、医生过分依赖影像学、医生的防御性医疗以及患者方面的因素.针对下腰痛患者不同的症状和体征选择个性化的影像学检查和诊断是解决该问题的主要办法.     

Political and clinical developments in analytical psychology, 1972‐2014: subjectivity,equality and diversity—inside and outside the consulting room

Utilizing Jung's idea of theory as a ‘personal confession’, the author charts his own development as a theorist, establishing links between his personal history and his ideas. Such links include his relationship with both parents, his sexuality, his cultural heritage, and his fascination with Tricksters and with Hermes. There follows a substantial critical interrogation of what the author discerns as the two main lines of clinical theorizing in contemporary analytical psychotherapy: interpretation of transference‐countertransference, and the relational approach. His conclusion is that neither is superior to the other and neither is in fact adequate as a basis for clinical work. The focus then shifts to explore a range of political and social aspects of the clinical project of analytical psychology: economic inequality, diversity within the professional field, and Jung's controversial ideas about Jews and Africans. The author calls for an apology from the ‘Jungian community’ for remarks about Africans analogous to the apology already issued for remarks about Jews. The paper is dedicated to the author's friend Fred Plaut (1913‐2009).     

The teachings of honorary Professor of Psychiatry Daniel Paul Schreber, J.D., to psychiatrists and psychoanalysts, or dramatology's challenge to psychiatry and psychoanalysis

The paper addresses the question: How does one read Schreber? Should one read ideas into his text to make sense of it, or should one listen to Schreber's own ideas? Freud read theories into Schreber and so did generations of psychiatric and psychoanalytic readers thereafter, creating Schreber, a myth. Looking for Schreber, the man, the author read Schreber from the perspective of history and dramatology so as to retranslate symptoms, syndromes, and systems back into Schreber's life dramas. As an interpreter and thinker in his own right, Schreber crafted a multilayered first-person narrative containing many lessons useful to patients, psychiatrists, and psychoanalysts.     

Diagnosis and differential diagnosis of myasthenia gravis]

The author describes the possibilities of diagnosis and differential diagnosis of myasthenia gravis. The data is based on the literature and on case reports of personal observations of more than 270 patients with myasthenia. He inaugurates his own classification of myasthenia comprising of 8 types, among which there is one particular clinical type, described first by the author. The different problematic types of myasthenia are discussed together with the most important diagnostic tests and the principles of differential diagnosis. The clinical and pathological study is completed by illustrations.