三甲医院启动临终关怀的现实冲突与对策

结合临床医生所遇到的真实案例,对启动临终关怀在三甲医院遇到的各种约束条件与现实问题进行分析,提出多数三甲医院及城市在临终关怀的资源配置明显不足。一方面临终患者的高治疗费用客观上带来三甲医院收入的增加,另一方面受床位、医保条令等制约,三甲医院又不能提供满意的全方位临终关怀服务;临终关怀患者所需服务内容多样,需要多方面专业人士共同努力。我国死亡教育相对缺失,三甲医院与其他医疗机构在临终关怀的分工与衔接还不完善等,对比提出相应的对策与建议。     

从道家“顺应自然”视角看《红楼梦》养生方式

道家“顺应自然”思想对中国古代医学有深远影响,《红楼梦》作为古代经典小说,其生活习惯场景的描写可使我们了解古代贵族的养生方式。文章从道家“顺应自然”的三个观点出发,结合《红楼梦》养生方式,分析其具体的保养过程及对健康的作用。首先通过适度养生观,分析质朴养生及有节养生思想在《红楼梦》中的具体应用;其次通过相对养生观,分析平衡养生及辩证养生思想在《红楼梦》中的实施过程;最后通过和谐养生观,分析自然养生及无为养生思想在《红楼梦》中的保养方式。     

客观地看待慢性乙型肝炎抗病毒治疗

乙肝病毒(HBV)感染是我国肝硬化和肝癌的主要致病因子,因此抗HBV治疗十分重要。但是,由于对抗HBV的治疗现状不够了解,不少人在盲目追求彻底清除体内的HBV,以至于弄巧成拙,所以,有必要客观地看待慢性乙型肝炎的抗病毒治疗,以求得到最佳的治疗效果。     

慢性乙型肝炎治疗目标及策略解析

慢性乙型肝炎治疗的目标是最大限度地长期持续抑制或清除乙肝病毒,减轻肝细胞炎症坏死及其所致的肝纤维化,延缓疾病进展,减少肝硬化、原发性肝细胞癌及其并发症的发生。治疗措施包括核苷类似物抗病毒治疗;干扰素抗病毒治疗;免疫调节治疗;抗炎治疗和抗纤维化治疗,其中抗病毒治疗是关键。     

Cue selection in verbal discrimination learning of retarded subjects.

A series of experiments was conducted to examine cue function in trigram verbal discrimination learning by retarded subjects. The issue was to determine the factors that control attention in this type of learning situation. The two variables of chief interest were trigram meaningfulness and reinforcement history. The major general conclusion was that retarded subjects employ complex cue selection strategies in solving a verbal discrimination involving compound verbal stimuli. Major findings were as follows: (a) Retarded subjects exhibit a response bias in favor of words over nonsense trigrams; (b) relatively little active cue selection based on meaningfulness was observed; (c) a compound stimulus discrimination was more difficult to learn than a discrimination involving single verbal stimuli; (d) compound and single stimuli may be processed differently in original discrimination learning; (e) cue position probably controls attention in compound discrimination learning; and (f) a frequency theory of verbal discrimination learning is supported by these data.     

Toward resolution of a longstanding controversy in personality disorder diagnosis: Contrasting correlates of schizoid and avoidant traits

Although the construct validity and clinical utility of separate schizoid and avoidant personality disorder (PD) categories has been controversial since avoidant PD was first introduced in DSM-III, few studies have compared individuals with schizoid versus avoidant features on variables relevant to their contrasting personality dynamics. Those few investigations that exist have yielded inconclusive results. In this study a mixed-sex sample of nonclinical participants (N = 123) completed the International Personality Disorder Examination Screening Questionnaire (IPDE-SQ) and self-report measures of attachment style, defense style, empathy, internalized shame, need to belong, rejection sensitivity, and social anhedonia. High levels of social anhedonia were uniquely predictive of schizoid features; high levels of need to belong and internalized shame were uniquely predictive of avoidance. These findings support retaining the two PD categories in future versions of the DSM. Supplementary analyses revealed that among women—but not men—schizoid and avoidant traits were positively and significantly intercorrelated; it may be that women show more of a blended schizoid–avoidant profile, whereas men display the more prototypical categorical profile where either schizoid or avoidant features predominate.     

Interpersonal problem solving as a mediator of behavioral adjustment in preschool and kindergarten children

An experimental model tested the mediating function of interpersonal cognitive problem solving skills on behavioral adjustment in preschool and kindergarten children. Relative to controls, nursery-trained youngsters improved in three such skills, kindergarten-trained in two. In both the nursery- and kindergarten-trained groups, increased ability to conceptualize alternative solutions to interpersonal problems significantly related to improved social adjustment. Consequential thinking also emerged as a clear behavioral mediator, especially among kindergarten-aged youngsters. Improvement in behavior could not, however, be attributed to change in causal thinking skills. Having identified two significant behavioral mediators in young children, a beginning has been made to isolate specific thinking skills, which, if enhanced, can contribute to healthy social adjustment and interpersonal competence at an early age.     

做一个大写的人:我们在阅读中与《孟子》相逢

如果我们愿意在阅读中与《孟子》相逢,我们就应该立志去做一个大写的人。从道德理想主义层面看,《孟子》要求我们“证性善”,确立人之为人的性善之本;期盼我们“恶乡愿”,拒斥八面玲珑的伪善之方。从文化守成主义层面看,《孟子》呼唤我们“友古人”,经由对优秀文化传统的回想而求证本根之源;促使我们“辟邪说”,通过对异端邪说的批驳而澄清智慧之旅。有理想有文化的人,才会是一个大写的人。无论对于针砭欲望横流的当下世态,还是对于建构人皆尧舜的未来愿景,这种人格的理论意义和现实作用都是不可低估的。     

The Experience of Prisoners’ Parents: A Meta‐Synthesis of Qualitative Studies

The parents of prisoners have long drawn the attention of researchers, due to their role in the etiology of criminality as well as the importance of their support of their offspring during and after incarceration. However, although studies have shown that the parents of prisoners experience high levels of distress, burden, and social stigma, research into their experience is only now beginning to emerge. This metasynthesis examined the limited body of qualitative research on the experience of prisoners’ parents, as an exploratory step toward advancing the understanding of their experience. Relevant terms were used to systematically search key databases. Ten small‐scale studies, which varied in focus, location, and disciplinary orientation, met the inclusion criteria. The synthesis produced four core themes, reflecting findings regarding parents’ (primarily mothers’) experience of their offspring's incarceration: parenting from a distance; the burden of care; troubled parental identity; and social reaction. Furthermore, the findings suggested a number of possible mediating factors of this experience, such as parents’ social capital and their cognitive appraisal of their offspring's criminality. These themes imply a possible experience of “imprisonment by association” among the parents of inmates and illuminate features that may be unique to them. Given the inherent limitations regarding generalizability of a metasynthesis and the heterogeneity of the experiences of the parents represented by the articles reviewed, the findings call for future large‐scale quantitative studies to explore the challenges and therapeutic needs of parents of prisoners regarding the themes identified.     

Looking where you listen: visual cues and auditory attention

In the non-laboratory environment, we are generally able to see the source of the sounds to which we are attending. In a preliminary examination of how and to what degree we might use this visual information, subjects shadowed one of two female voices when able to see the persons speaking (Experiment I) or when able to see, and thus precisely localize, the auditory loudspeakers (Experiment II). Selective performance was improved by being able to see the lip movements of the people whose voices were heard, and by being able to localize visually the sources of the voices.