专科医生应注重整体性和系统思维训练——由一例甲亢患者门诊长期误诊引发的哲学思考

临床医学专科的发展对促进医学科学的进步起到了重要的推动作用,尽管它可能缺乏整体性、系统性临床思维,但在可预见的将来,它仍是综合性医院医疗实践的主旋律,医学界应对此有较为清醒的认识.本文从哲学的角度分析了造成误诊的原因,然后指出防止或减少误诊的途径是培养科学的临床思维,并提出了在临床过程中培养整体思维和系统性科学思维的一些方法.     

Recent Court Decisions: A Quiz For APGA Members

Counselors must keep up with changing laws and court rulings. This article presents a short quiz for APGA members to test their current legal knowledge.     

Occupational floundering

The phenomenon of occupational floundering occurs when a person enters the labor market in search of full-time work without a chosen commitment to an occupational goal. It is a period of effort in which job seekers experience varying degrees of need deprivation and frustration. Floundering can be divided into three stages: the period of initial entry into the labor market; the shopping period; and the mid-career stage. Floundering is not necessarily as destructive a phenomenon as current vocational theories tend to imply, since it sometimes provides experiences that facilitate personal growth and self-acceptance as well as providing a means by which a significant portion of the labor force eventually becomes stabilized.     

Counseling Outcomes: Counselor Characteristics and Client Results

Eighteen counselors in one of the administrative areas of the California Department of Human Resources and 697 of their closed cases were studied in order to discover whether differences in employability outcomes did exist. The study attempted to answer the following questions: (a) How many clients achieve employability during their relationships with employment counselors? (b) What is the final disposition of cases that are closed other than employable? and (c) To what degree do counselors engage in placement activities and what influence do these activities have on employable closures? The study provides evidence that some counselors had significantly more clients achieve employable status than did other counselors.     

浅谈外科手术在重度肥胖治疗中的作用

目前在重度肥胖治疗中存在着孤立地,片面地看待疾病,对主要矛盾注意不够的问题,且过度依赖内科治疗。而外科手术对病态肥胖有着良好的效果,是去除代谢综合征(MS)主要致病因素的有效手段。但由于人们观念陈旧,临床上很少有人接受手术治疗。因此转变人们的观念是提高重度肥胖治疗效果的关键和必需的一步。     

DIMENSIONS OF COMPLIANCE-GAINING SITUATIONS

A seven-factor model of situation perception, including “personal benefits,”“intimacy,”“rights,”“resistance,”“dominance,”“situation apprehension,” and “relational consequences” was proposed. Confirmatory factor analysis was employed to test the fit of the model to the data. One sample (N=450) was employed to test a six-factor sub model (excluding relational consequences) and a separate sample (N= 270), employing a different situation, was utilized to test the seven-factor model. The proposed model proved to fit the data well (x²/df ratios of 3.14 and 2.97, respectively) and was superior to alternative models. Future research recommendations were provided.     

ART临床应用伦理调控的特点

解决ART应用中引发的伦理问题、难题的基本对策之一是加强医学伦理调控 ,推进医学伦理精神对医学过程的渗入 ,ART医疗机构伦理委员会是医学伦理调控体制化的表现和实现这种调控的重要途径 ,它以特定的主体形式和审查、咨询、教育、督查、建议等活动方式 ,形成对调控对象某种监督的客观效果。     

习得年龄对客体和动作图画口语命名的不同影响：ERP研究

词汇习得年龄指人们最早理解单词意义时的年龄, 已有研究发现早习得词汇的阅读反应时间短于晚习得词汇, 研究者对于词汇习得年龄效应的认知机制存在争论。本研究运用事件相关电位技术, 考察了词汇习得年龄(早与晚)对客体图画和动作图画命名的影响。研究中采用图画命名任务, 要求被试在看到图画后迅速且准确地说出图画名称。结果发现早习得名词的命名快于晚习得名词, 而早习得动词的命名却慢于晚习得动词; 习得年龄对于名词产生的影响发生在图画呈现后的250~300 ms之间, 表现为早习得名词波幅小于晚习得名词, 而习得年龄对于动词产生的影响发生在图画呈现后的200~600 ms之间, 表现为早习得动词波幅大于晚习得动词。这表明名词产生中的习得年龄效应发生在词汇选择阶段, 支持了语义假设的观点; 动词产生过程中的习得年龄效应出现在多个加工阶段, 包括了词汇选择、音韵编码和语音编码阶段, 这与动词语义的多重性及其与动作相关的脑区激活有关, 支持了网络可塑性假说的观点。     

肝硬化与现代医学模式的关系

1　诊断中生物因素是相对突出的病因通常在分析肝炎后肝硬化的病因时,不可否认的是:生物性因素是相对突出的病因。急性肝炎→慢性肝炎→肝纤维化→肝硬化→肝衰竭,成为传染病医生心目中的法定公式。但是在工作中,我们也观察到了另外一种事实,曾经是重病人,经抢救治疗后,多...     

小学汉语儿童英语口语产出形式的发展

以小学二、四、六年级共82名学生为研究被试, 通过自我介绍、被试主动发问、看图说话和角色扮演4种任务对其英语口语产出形式进行了测查。研究结果发现:(1)在小学汉语儿童英语口语产出形式上, 随着年级的升高, 套语的比例随之减少;其他语法错误句随年级升高而增多;正确的非套语也随年级升高而增多, 在四年级达到一个比较稳定的水平;(2)二年级儿童的英语口语产出形式以套语为主;四年级儿童的口语产出形式中正确非套语比例增加;在六年级儿童的口语产出中, 简化句比例增加, 但套语仍然是主要的一种口语产出形式。