临床经验对诊断的双重作用及改造

文中用辩证唯物主义的观点,阐述了临床经验的定义、来源及指导实践过程中的意义,指出其具有促进诊断和引起误诊的双重作用,并用临床病历例子详细说明其双重作用的形式、导致结果及产生的原因。指出临床经验的双重作用在临床工作中的重要性及局限性,提出对经验的改造完善途径,以能充分表现出其促进诊断的作用,而最大限度降低其导致误诊的程度,发挥在临床工作中的良性作用。     

Primary health care for women: What is it and who provides it?

Recent federal policy has highlighted historically underrecognized women's health issues. Women comprise the majority of the population, especially the elderly. Women's health care needs, utilization patterns, and outcomes vary from those of men, and often among each other. Primary health care services for women are multidisciplinary and emphasize prevention, education, and early intervention as well as treatment. Psychologists and other primary health care providers can collaborate to provide their services in a cost-effective manner that optimizes quality of care and comprehensive health care.     

Evaluating pediatric psychology consultation services in a medical setting: An example

We examined the nature of referrals to a health center-based pediatric psychology service from 1990 to 1993 and assessed the satisfaction of health professionals with these services. Archival evaluation of 1467 records showed that over half of the consultation requests came from general pediatrics, pediatric neurology, and surgical services and that 70% of the psychological services were delivered on an outpatient basis. The most frequent referrals were for cognitive/neuropsychological evaluation and externalizing behavior problems. Pediatric psychology trainees were involved in 94% of the consultations. Survey of health professionals (n = 143) indicated very high overall satisfaction with the quality of services delivered. Presenting problems yielding the greatest likelihood for future consultation requests were behavior problems, child abuse, coping with illness, and depression/suicide. Results are discussed in the context of previous evaluations of pediatric psychology services and recommendations for future evaluation research.     

Analysis of long-term stress reactions in emergency room patients: An initial study

The psychological stress reactions of 44 family medicine patients who were treated in the emergency room were examined approximately a year after the event. Patients were assessed on several psychological measures, including one for posttraumatic stress disorder (PTSD), and on their perception of how stressful the event was initially and now. Results show continuing stress reactions related to the emergency room event. Three patients endorsed symptoms indicating full PTSD and 13 appeared to have at least partial PTSD. Age appeared to be a factor in the presence of stress symptoms and in degree of perceived communication with the physician.     

Resistance and adherence to the norms of genetic counseling

Genetic counseling for women of advanced maternal age who are considering prenatal testing continues to be based on a principle of nondirectiveness. We interviewed 11 genetic counseling students and four counselors about how they experience and manage, in practice, the tensions between the ideology of nondirectiveness and the acknowledged reality that one can never be truly nondirective. We found that our respondents creatively resolve this tension—simultaneously resisting and adhering to the values of nondirectiveness and information-giving—in individual and situation-specific ways. This resolution is facilitated by the extent to which information given to counselees is fluid, mobile and context-dependent, but these very features of information also have critical implications for both the norms and the practice of genetic counseling.