人文关怀与临床思维的整合与互动——一例罕见病的诊治经过启示

医学人文关怀一直以来与医学技术相伴而生,相互依存.然而,在当代医学技术已进入后基因时代的今天,医学人文关怀还部分地被理解为“临终关怀”.事实上,做好医学人文关怀,不仅是人文、伦理的需要,同样对指导临床思维、提高诊疗水平有重要意义.但目前国内外医学教育和临床医疗实践中,关于人文关怀与临床思雏整合与互动的议题还极少见诸报道.而笔者近期在对一例罕见病的成功诊治经历中,体会到了医学人文关怀对临床诊疗水平的重要作用.     

青少年网络道德与其网络偏差行为的关系

青少年已经成为中国互联网的最大用户群体,他们在使用互联网中表现出的偏差行为与道德的关系值得关注。该研究使用问卷法探讨了496名青少年的网络道德特点与网络偏差行为表现以及二者之间的关系。结果发现:(1)青少年的网络道德表现较积极,网络道德认知、情感和意向之间存在显著正相关;(2)青少年的网络偏差行为不算严重,但男生的网络过激行为和网络色情行为显著多于女生,且网络过激行为随着年级升高而减少:其中网络攻击性、易怒、敌意和冲突水平都随着年级的增长而呈下降趋势;(4)青少年的网络道德认知和意向对网络偏差行为有反向预测作用,网络道德情感不能预测其网络偏差行为表现。网络道德越积极,表现出来的网络偏差行为越少。     

幼儿非形式推理能力的发生与发展

针对在儿童非形式推理能力发生研究中评价标准不一和研究结果中发生年龄不同的问题,在论证并提出幼儿非形式推理发生评价标准的基础上,采用提示访谈法对333名3-6岁幼儿的非形式推理做了考察。结果显示:幼儿的我方推理普遍在3岁3个月～3岁9个月发生;他方推理普遍在4岁～4岁6个月发生;反驳推理普遍在4岁9个月～6岁发生。幼儿在推理过程中提出的理由数量随年龄的增长而增多,年龄差异显著,但无显著性别差异。研究中建立的评价指标体系可以有效测量幼儿非形式推理的发生和发展。     

医学书面语体的特征研究

以病历、医嘱、处方、检验报告、诊断学等教科书中书面语言为基础,对医学书面语体的内部结构和外部要素进行分析,认为医学书面语体作为一个相对新型的语体,在语词、句法、辞格和篇章等方面有显著的特征。还深入研究了这些特征与相关联的语言外部要素间联系。     

医学书面语体的特征研究

以病历、医嘱、处方、检验报告、诊断学等教科书中书面语言为基础,对医学书面语体的内部结构和外部要素进行分析,认为医学书面语体作为一个相对新型的语体,在语词、句法、辞格和篇章等方面有显著的特征.还深入研究了这些特征与相关联的语言外部要素间联系.     

辽宁省临床医师认知和使用循证医学情况调查

为了解临床医师使用循证医学(Evidence-Based Medicine)的知晓度,获得基线资料,为卫生部门提供决策依据,课题组对辽宁省三级甲等医院的243名临床医师采用问卷调查.结果显示,临床医师受经验医学的束缚,未能将循证医学运用到医疗实践当中.为提高我国临床医学水平,在临床医师中推广循证医学非常必要.     

我国公立医院治理机制改革模式及效果研究

近年来,我国上海、北京海淀区、苏州、潍坊、青岛、无锡等地率先进行了公立医院治理机制改革的尝试,通过建立不同性质的中间机构来理顺政府和公立医院之间的委托代理关系.分析我国公立医院治理机制改革的不同模式以及政府治理机制改革对公立医院行为和政府监管效力的影响.     

Client-Centered and Family-Centered Care: Refinement of the Concepts

Occupational therapy has emphasized the relationship between the therapist and the client. The occupational therapy guidelines for client-centered practice produced in the 1980s by the Canadian Department of National Health and Welfare and the Canadian Association of Occupational Therapists (Task Force on Guidelines for the Practice of Occupational Therapy, 1983) has had variable use over the years. While occupational therapists believe in the principles of client-centered care, the philosophical concepts have been difficult to fully implement and also seem narrow in light of all the external forces and challenges posed by today's clients and their rights, and the ethics of medicine. Other concepts need to be in place to facilitate the true constructs of client-centered care. A historical overview of the medical perspective and the occupational therapy perspectives on client-centered and family-centered care are reviewed. Lessons learned from the various iterations of client-centered and family-centered care are posed for consideration of a newer more inclusive relationship-centered concept for occupational therapy.     

Nonsuicidal Self‐Injury in College Students: The Role of Perfectionism and Rumination

A paucity of research exists examining personality and cognitive characteristics that may contribute to nonsuicidal self‐injury (NSSI). The purpose of the current study was to clarify the contribution of perfectionism and rumination, along with depression and anxiety, to NSSI within a sample of 170 college students. Group comparisons revealed that participants with a history of NSSI endorsed significantly more rumination and depressive and anxious symptoms then non‐NSSI controls. Results regarding perfectionism were mixed, with NSSI participants differing from controls on select aspects of perfectionism. Results suggest higher levels of depression and anxiety and a ruminative cognitive style may increase vulnerability for NSSI; however, further research is needed to clarify the contribution of perfectionism.