过度医疗、适度医疗与诊疗最优化

过度医疗与过度服务有所不同.适度医疗应当是为患有某种疾病的病人提供有效、安全、便捷、耗费少的医疗服务.最优化的医疗是一种包括以优质的医疗服务实现了最佳疗效、最安全、痛苦最少、最便捷和费用低的医疗.一般地说,最优化的医疗首先应当是适度的医疗.最优化的医疗比适度医疗有更高的要求.不宜用优质医疗取代适度医疗,也不宜将适度医疗改称为最优化医疗.我们可以将适度医疗作为保健服务的基本要求,而将最优化医疗作为努力目标,一种理想化的目标.在满足人民的基本医疗、实行基本医疗保险过程中,我们更应当提倡适度医疗.     

关于医学人文关怀的几点思考

医学兼有自然科学和人文社会科学双重属性.其核心理念即人文精神决定了医疗服务必须体现人文关怀,这是高质量医疗服务和医学模式转换的必然要求,并且有助于减少医疗纠纷,提升医院的竞争力.     

西方国家医疗公正基本理论论析

西方国家医疗公正基本理论分为内容的公正和形式的公正。在内容公正方面西方国家有三种重要的医疗公正理论,它们是功利主义、极端自由主义、平等主义。它们对于西方国家制订医疗政策有很大影响。在形式公正方面,近来医疗程序公正理论影响很大。     

Depression in Primary Care: Comorbid Disorders and Related Problems

Identifying and treating depression has been a major focus in primary care over the last decade. Unfortunately, treatments have not been as successful as originally hoped. The current study investigated factors that may contribute to poor outcomes in a sample of VA primary care patients. Results indicate that 15.5% of the patients in this investigation had significant symptoms of depression. The vast majority (89.6%) of these patients also had significant symptoms of at least one additional comorbid psychiatric condition. Furthermore, an association between depression and unhealthy behaviors (smoking, not exercising) was demonstrated. Finally, sexual dysfunction and chronic pain were more frequently observed in individuals with depressive symptoms. These findings illustrate that depression is only one of many problems for most primary care patients identified with depression. A multidisciplinary team in primary care is recommended to provide a coordinated approach to the treatment of depression and its associated problems.     

Preschool child care and parents' use of physical discipline

Parenting practices, including the use of physical discipline, are shaped by multiple influences. Although much research focuses on how parent, child, and dyadic characteristics shape parenting practices, extra‐familial resources may also play a role. This paper focuses on how children's experiences of child care during the preschool years may affect one aspect of parenting—discipline practices. Using a rich, nationally representative data set, we explore the correlation between children's participation in centre based care, Head Start, or other non‐parental care arrangements and parents' use of physical discipline, and related phenomena, parents' experience of domestic violence and parenting stress. We conduct probit regressions of parents' use of physical discipline, and parents' experiences of domestic violence, on preschool child care experiences. For disadvantaged groups of children, who have higher risks of experiencing physical discipline and witnessing family violence, we find that Head Start participation is associated with an increase in the likelihood that parents say they never spank their children and reduction in reports of domestic violence. And, for children in two‐parent families, Head Start is associated with an increase in the likelihood that parents say they never spank their children and the likelihood that they do not say they would resort to spanking in a hypothetical situation. However, we find no evidence that non‐parental child care is associated with a lasting reduction in parenting stress. Copyright © 2005 John Wiley & Sons, Ltd.     

Bioethics—Eleven Approaches

Abstract:  Using a case study, the author reviews 11 different approaches to bioethics, examining both their implications in clinical practice and their importance for clergy. In addition to the popular stress on patients' rights and principles in bioethics, the approaches include perspectives drawn from feminist ethics, phenomenology, ethnography, covenant views, virtue ethics, postmodernism, and casuistry. Lebacqz shows that each perspective may be important for stressing something different in the clinical setting, and suggests that clergy should be prepared to extend the range of views that may be operating in a given case.     

Pastoral Ministry and the Fleshly Body

This paper will explore the fleshly body of the pastor/priest/liturgist/caregiver and its engagement with the fleshly bodies of the ones given to their care. Its purpose is to address the physicality of being involved in pastoral ministry.     

The Abuse of Power: A View of Sexual Misconduct in a Systemic Approach to Pastoral Care

The article explores the dynamics of transference and countertransference in hierarchical relationships which exist between clergy and lay persons, both in the parish setting, as well as in the pastoral counseling relationship. It is of utmost importance that the power differential be consciously acknowledged by pastoral caregivers so that appropriate boundaries can be exercised. All too often it is the negligent, careless, or unconscious disregard for this power dynamic by individuals providing pastoral care that has led to the sexual violations recently surfaced within our religious institutions. Acknowledgement of the imbalance of power, and its consequences for both clergy and parishioner, is essential in a systemic model of pastoral care.     

医疗活动中言语行为特征解析

随着医学模式的变化,医疗的人文关怀的提出,医疗活动中的言语行为也出现了新的特征.从现代医学的发展为医疗言语行为提供了大的语用背景、患者群体的特殊性及其演变延伸了言语行为的情感功能、语用环境的复合性凸现了言语行为的道德水准、医疗活动的风险特质决定了医疗言语行为的规范准确性等四个方面对这种特征加以解析.     

知情权与新生儿重症监护病房(NICU)患儿父母的信息交流技巧

在新生儿重症监护病房(neonatal intensive care unit,NICU)中接受治疗的危重新生儿约90%结果良好,而这些患儿的父母100%都在此过程中遭受不同程度的心理创伤.患儿父母及其家人应被充分告知患儿的病情、治疗方案及可能的预后,这是他们拥有的知情权.在临床工作中,怎样运用良好的信息交流技巧让患儿父母充分理解病情、配合治疗又不过分紧张这对患儿的康复比对患儿实施具体的诊疗方案更重要.从患儿父母、医护人员、人文关怀的角度探讨NICU医护人员与患儿父母之间信息交流的技巧.