Improving fairness in coverage decisions: performance expectations for quality improvement

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.     

Ethical guidelines for use of electronic mail between patients and physicians

This report examines the ethical implications of electronic communication, focusing on the use of electronic mail (e-mail), considers its impact on a previously established patient-physician relationship, and the limitations in using e-mail to create a new patient-physician relationship. In its recommendations, this report offers guidance to physicians who use electronic mail to communicate with patients and online users. These guidelines maintain that e-mail should not be used to establish a patient-physician relationship, but rather to supplement personal encounters. When using e-mail, physicians hold the same ethical responsibilities to their patients as they do during other encounters and that information must be presented in a manner that meets professional standards. The report requires that physicians notify patients of e-mail's inherent limitations and that patients be given the opportunity to accept these limitations prior to the communication of privileged information. Finally, physicians should be aware of privacy and confidentiality concerns when using e-mail to communicate with patients.     

谈生理功能的整体调节方式

面对生理学整体水平研究的挑战,应研究生理功能整体调节方式。这一调节方式的基础是神经内分泌免疫网络,它的特征是依照个体特点的分型。讨论其混沌特性,研究方法及医学的影响。     

进化,从自然主义到自由主义

生物进化体现了生物世界从简单到复杂,从低级到高级的普遍现象,整个进化史可以人类社会出现的界划发为自然状态的进化和人类智慧,意志指导下逐渐展开的人工进化或自由进化,人类的进步必须要和自然环境和谐发展科学必将吸取系统论,理性论和人文精神而成为人类迈向自由地的有力武器。     

状态医学——中医学的现代概念

为人体机能状态定义,以中医同病异治,异病同治,说明中医学的本质是状态医学。人体机能状态正常与否的第一个感受者是自我,因此,症状是诊断状态的第一要素,体征是客观依据。由于人体机能状态并非各器官机能的简单加减,因此,现代医学的理化指标在诊断状态时,只供参考。状态医学的模式实质上就是现代中医学,其诊断依据、状态的评价与西医截然不同。在引入现代病因病理学说的基础上,状态医学是一个新的临床诊疗体系,其药学体系有如镜面,反映状态医学的各种特征。     

病人自主权及其保障条件

病人自主权是病人的基本人权之一,是保障其生存权与健康权的基本条件,也是医学人道主义的重要内容。同时,在医疗活动的权力制衡中,代表病人权利的权力是必不可少的要素之一。因此,病人自主权必须受到充分的尊重。病人自主权要想得到充分的保障,必须以全民的权利意识觉醒为条件,以完善的法制与法治为保障,并要符合健康目的,遵从科学规律。     

内隐学习研究的现状及其争议

本世纪７０年代,Ａ．Ｓ．Ｒｅｂｅｒ等人在概念形成的研究中提出了“内隐学习”的概念,从而对概念形成及有关概念学习的所有分析性理论提出挑战,在心理学界引起轰动,使内隐学习的研究成为热点。直到现在,内隐学习研究者们取得了一系列的研究成果,促进了心理学特别是认知心理学的发展。但由于其研究尚处于初级阶段,所以其内部也存在着诸多争议。本文拟就内隐学习的一般发现及有关争议加以探讨,以期引起进一步的研究。     

成人日常问题解决的老化研究

日常问题解决能力是近十几年来老年心理学中研究比较活跃的一个领域。本文介绍了有关日常问题解决研究的四种理论,即心理测量的智力内隐理论、形式后思维的辨证思维理论、信息加工理论和社会认知与智慧理论,及其初步的研究成果,并进一步指出在理论上整合和在实践中开展干预的研究方向。     

Evaluation of outcome in school consultation

To further understanding regarding how content of change, degree of change, and initial level of functioning influence consultants' evaluation of consulation outcome, 14 mental health consultants completed a questionnaire. For each of the 18 prepost consultation ratings on the questionnaire (2 context × 3 degrees of change × 3 initial levels = 18), consultants rated the success of consultation and the degree to which they would like to have been the consultant. Analysis of variance results for both dependent measures indicate main effects for degree of change and initial level. Neither main effects for content nor interaction effects are indicated. It appears that consultants perceive consultation as more successful with and prefer working with consultees who improve the most and who function at a higher initial level.     

氯丙嗪、氯丙嗪-苯丙胺颉颃作用对猕猴学习和行为的影响

精神药物对学习和行为影响的实验研究。开始于氯丙嗪和二乙基麦角酰胺(LSD)的诞生。自从1954年首次报道氯丙嗪对精神病患者的疗效后,精神药物对学习和行为影响的研究一直十分引人注意。早期的研究强调精神药物和学习的动机有关,因此以食物巩固为基础的正动因学习和以电击巩固为基础的负动因学习间,被认为存在本质差