开放医疗市场 强化政府责任 解决看病难

当前对医疗改革的批评较多,不少人认为是过度市场化的结果。但是,“过度市场化”的问题不能一概而论,可以从两个方面来分析,从医疗服务方面来说,有过度市场化的倾向;但是从医疗资源的配置或投入来说,市场又没有充分放开。所以不能简单的或笼统的把医改的问题归咎于市场化。该开放的医疗市场未开放,政府责任不到位,才是当前中国医疗改革的问题所在。     

Dementia care‐giving in black and Asian populations: reviewing and refining the research agenda

Despite the increased prevalence of dementia little work has been done to explore the extent and nature of care‐giving in black or Asian‐UK populations. Evidence that does exist suggests that the consequences of care‐giving are significant but different from those experienced by white carers and are mediated by a number of culture‐related factors. These include: ethnically specific conceptualisations of dementia; expectations of family duty; religiosity; the adoption of positive re‐appraisal strategies, and beneficial outcomes. Present approaches to research are narrow, do not take account of cultural dimensions and employ terminology and care‐giving frameworks which are of limited relevance. That the evidence base is characterised by small‐scale studies, and weak methodology further undermines its validity. Research deficits are systemic and fundamental and are both conceptual and methodological. A key contribution would be the development of a multi‐dimensional theoretical model that takes account of the role played by culture, ethnicity and structural inequality in shaping care‐giving experiences and profiles. Incorporating the perspectives of black and Asian carers, and the influence of the life course of individuals and communities and employing qualitative methods would also influence the direction of research, improve its quality and generate knowledge in this underdeveloped field. Copyright © 2005 John Wiley & Sons, Ltd.     

Parent-School and Community Partnerships in Children's Mental Health: Networking Challenges, Dilemmas, and Solutions

Inter-agency collaboration, service coordination, and the creation of successful partnerships among parents, teachers, and human services professionals continues to be a challenge for the development of responsive community-based systems of care for at-risk youth and their families. We explore how one inner-city neighborhood struggles to create successful community partnerships through traditional networking strategies. Our findings identify networking strategies that appear to work and those that do not. Recommendations for improving communication are provided.     

Multidimensional treatment foster care (MTFC): results from an independent replication

This study examines 24‐months post‐baseline outcomes for thirty‐five Swedish antisocial youths who received either treatment in multidimensional treatment foster care (MTFC) or treatment as usual (TAU). MTFC is a community‐based treatment programme that has been successful in treating chronic juvenile offenders in the USA. This study is the first randomized control study outside the USA. The youth treated in the MTFC programme consistently showed some statistically significant positive treatment effects compared to the youth exposed to TAU. The results suggest that MTFC might be an effective method in treating youth with severe behaviour problems in a Swedish context. The authors conclude that the programme ought to be of great interest for Swedish social services as an alternative to traditional care.     

影响ICU护士落实“知情同意原则”原因及对策

重症监护（intensive care unit,ICU）医生越来越重视在诊疗活动过程中的知情同意权,各种重要诊疗活动都与患者和家属沟通,并取得口头或文字上的同意,但部分护理人员对知情同意原则不重视,在环节中落实不力,从而易引发护患纠纷。而保证患者获得知情同意权是护理人员必须落实的义务,护士的告知是维护患者知情同意权和...     

关怀伦理的介入：医患关系重构的新视角

梳理有关学者的关怀伦理理论观点,并基于关怀伦理的相关思想对疾病状态下患者的特性（脆弱性、自主性和依赖性）进行分析,在此基础上,讨论目前医疗机构中主流医患关系模式理论（包括律法关系、家长制关系和自主决策关系）的局限性与不足,并将这类主流医患关系说纳入到基于关怀的医患关系之中,以重构适用于当前医疗行为模式和医疗行业现状、体现己他两利关怀思想的医患关系模式,最后阐述了基于关怀的医患关系中的“关怀”实践路径,包括引导性双向叙事、同情与移情以及关怀美德。

     

社区护理病房中长期慢性病患者的照料服务机制——基于质性研究的方法

现有社区护理病房照料服务存在不能充分满足患者的深层需求、生活质量不佳的问题。访谈材料显示出由于照料者缺乏对“善终”概念的认知,患者、家属以及医护人员的三方关系中,患者处于权力的弱势地位,主体之间在讨论死亡相关问题上存在严重的脱节。患者的意愿从表达、传递、实施等环节中都存在阻碍,患者“善终”的需求无法实现。“以患者为中心”的照料理念应在现有照料服务中加以推广,通过提升社区照料质量来满足医学关系、家庭关系和患者自身利益的既定政策目标。

     

Parent Perspectives on Family Involvement in Therapeutic Foster Care

There has been an increasing focus on family involvement in the treatment of children with serious emotional disorders, but it has received only limited attention in relation to out-of-home placements. I present the findings from a qualitative study of family involvement from the perspectives of parents whose children were placed in therapeutic foster care (TFC). Parents' perspectives on their involvement in placement decisions, relationships with professionals and TFC providers, practices related to family involvement, barriers to involvement, and strategies to enhance family involvement are described. Parents of children in TFC wanted to have contact with their children and to participate in decision making. They described relationships and practices that contributed to their involvement.     

晚期癌症患者治疗决策的思考

现代医疗尚无法治愈所有晚期癌症。现实与期望之间的较大差距,挑战晚期癌症治疗的临床决策。WHO强调为防止资源滥用,应确保抗癌治疗只用于可获益阶段。对于晚期癌症患者的治疗决策,除遵循规矩原则和循证医学证据原则外,还应该遵循尊重患者意愿、社会公平的美德原则。大多数癌症患者需要接受姑息治疗。姑息治疗为患者及家属提供既简便又经济的医疗服务。     

签署知情同意书有助于改善医患关系

当前医疗活动中由于缺乏人文关怀、患者对医务人员信任度下降以及医患之间信息不对称,导致现阶段医疗投诉以及医疗纠纷逐年上升,投诉和纠纷内容多样且性质趋于严重复杂。在签署医疗知情同意书时,适时给予病人情感上的关爱,重视病人心理需求,采取医学技术与人文关怀相结合的医疗活动,有助于在现代医学模式基础上构建和谐的医患关系。