建立我国医事仲裁机制的再思考

仲裁是解决医疗纠纷的有效机制.然而,我国至今仍未建立医事仲裁机制.在考察我国仲裁解决医疗纠纷的现状和成因的基础上,提出构建医事仲裁机制建议.     

论疾病的诱因

疾病诱因是医学实践中的一个重要现象,对疾病的预防、诊断、治疗和医学科研有显著意义。由于种种原因,对疾病诱因一直缺乏深入研究。本文提出并探讨了以下问题：研究疾病诱因的意义;疾病诱因的本质属性;疾病诱因与病因、危险因素的关系：“诱发”和“疾病危险因素”两概念辨析;疾病诱因的不同类型;疾病诱因发生作用的一般机制和医学实践中处理诱因的一般对策。     

An ethical excursion through labeling the mentally retarded

Review of a representative body of research data concerning the effects of the “mentally retarded” (MR) label on parents, teachers, college students, nonretarded children, communities, and persons labeled fails to support the extravagant claim of some investigators that the labeling process has psychologically damaging effects upon the individuals labeled as well as society. Negative reactions to labels could be minimized by extensive public education and counseling. Labels should be retained as formal instruments essential to establishing the eligibility of the retarded for special assistance, and for maintenance of communication within and between disciplines, without which contemporary society could not operate. An argument for the judicious use of labels is fashioned, recommending replacement of the MR label by “AD” (adaptively deficient), in keeping with the modern view of mental retardation as a psychosocial challenge deemphasizing IQ and requiring adjustment of the whole personality to demands of a complex environment (e.g., coping skill, motivation). Parents, teachers, friends, employers, and public officials could support the AD's struggle to effectively participate in community life by promoting the perennial values of respect for human dignity, fairness, equality, autonomy, and compassion. As a result of monitoring the success of such programs in all settings, public policy administrators could formulate rational approaches to improvement of service programs in the national interest.     

神经症患者MMPI模式特点的研究

本研究总结了1112例神经症患者MMPI测查结果,探讨了神经症患者MMPI的模式特点。研究结果表明,本症患者除K、Mf-f分外其余量表原始分均显著高于常模。以中国T分60为界,大部分神经症患者都表现在1、2、3、7量表上升高,两点编码模式为12/21、13/31、23/32或27/72型。其基本符合率和完全符合率在70％以上。本文还探讨了神经症各型的编码特点,它与临床表现相符。故作者认为MMPI对神经症患者的心理状态和心理特征评定和描述,可为本症的诊断和心理治疗提供较为客观的依据。     

Spiritual Health and Outcomes in Muslim ICU Patients: A Nationwide Cross-Sectional Study

The aim of the present study is to describe how religiosity and spirituality affect the psychiatric morbidity of Muslim intensive care unit (ICU) patients. We conducted a prospective nationwide cross-sectional study of ICU patients discharged from 45 medical centers spanning 31 proivinces in Iran. Adults (age ≥ 18 years) admitted to the ICU and treated with invasive mechanical ventilation were eligible. Nine validated survey tools were administered to detect direct and indirect associations between spiritual health (SH) and depression, anxiety, and post-traumatic disorder. The Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale—Revised (IES-R), Post-Traumatic Stress Syndrome 14 question (PTSS-14) quality-of-life (QoL), and quality of patient to physician or nurse communication (PP-QoC and PN-QoC) scales were modeled through two mediators by structural equation modeling (SEM). Sex, ICU type, LOS, and APACHE II score were added in the independent variable list. 338 eligible patients were discharged from the ICUs during the study period. 56 were excluded (clinical status), and 282 were administered the survey. 278 returned it, with 272 complete and 6 partial responses. SH displayed no direct or indirect association to QoL. SH was indirectly associated with decreased depression and anxiety (B = ? 0.081, p < 0.05) via PP-QoC mediator. Both direct and indirect positive associations were observed between SH and IES-R (B = 0.293, p < 0.05; via PP-QoC) and PTSS-14 scores (B = 0.267, p < 0.001; via PP-QoC). Medical ICU location was associated with decreased PTSS-14 scores via the same mediator. In this survey of Muslim ICU patients treated with invasive mechanical ventilation, SH correlated with decreased depression and anxiety, but paradoxically increased post-traumatic stress. The most influential mediator was patient–physician quality-of-communication.     

供给诱导需求研究综述

主要从概念界定、研究方法、解释假说与理论模型以及主要研究结论等方面对供给诱导需求的相关研究进行综述。虽然国外学者对供给诱导需求进行了大量研究,但是在理论和实证研究方面,还没有形成一致意见。尽管如此,借鉴国外的研究方法和结论,针对我国医疗卫生体制中的供给诱导需求问题进行研究将具有重要意义。     

美国健康战略及启示

介绍了美国健康战略出台的背景,并重点介绍了美国“健康公民2010”战略的目标、优先领域、主要健康指标以及相应的行动计划,比较了美国“健康公民2000”和“健康公民2010”的异同,在此基础上总结了美国健康战略发展的基本特点与经验,并提出了对我国制定和实施“健康中国2020”战略的启示。     

论医务社会工作中的价值观冲突和伦理困境

医务社会工作遵循着社会工作专业的一般价值观和伦理守则,并在此基础上,发展出其特有的价值观和职业伦理。对医务社会工作实践中的价值冲突和伦理困境及解决这些难题的指导原则等问题进行探讨,以期使医务社会工作者对工作实践中可能遇到的相关问题有初步的认识,并为他们在行动决策时提供参考和借鉴。