ICU谵妄患者病因分析以及处理

分析急诊ICU患者出现谵妄症状的原因以及处理对策。分析总结我院急诊ICU3年间所有患者的资料,发现20．2％的患者出现谵妄症状,原因为：（1）疾病相关;（2）药物相关;（3）监护环境等多种因素作用结果。经过调整治疗方案、加强心理护理后,需要镇静药物的仅为谵妄患者的19．7％。因此寻找谵妄原因很重要,治疗重点在于去除谵妄原因以及相关促发因素。     

中西医结合脑卒中治疗新模式的探讨

卒中是危害人类健康最严重的疾病之一,其发病率高、死亡率高、致残率高,已成为世界范围内的健康问题。卒中单元已被证实是目前治疗卒中最有效的方法,组织化卒中医疗作为卒中单元的进一步发展,成为脑卒中治疗模式新的趋势;中医强调整体观念和辨证论治,将中西医结合起来,建立和实施中西医结合脑卒中治疗新模式,有助于降低脑卒中患者的死亡率,减少并发症,提高生活质量。通过探讨一种中西医结合脑卒中治疗模式的特点和运作方式,为脑卒中治疗模式的发展提供新的思路。     

Intimate partner cohesion and military unit cohesion: Different types of interpersonal relationships each uniquely predict soldier well-being

Although research on military populations has found that measures of personal well-being are correlated with both intimate partner cohesion and military unit cohesion, it is not clear how these correlations should be interpreted. Based on Relationship Regulation Theory, it was expected that each type of interpersonal relationship would have independent effects, that each would uniquely predict outcomes, and that effects would remain significant after controlling for person-level traits and experiences, such as trait resilience and exposure to combat. A sample of 273 active-duty military personnel completed self-report measures of cohesion in two types of interpersonal relationships (intimate relationships and military unit relationships), two control variables (trait resilience and combat exposure), and three outcome variables (well-being, negative emotionality, and trauma-related stress). Results indicated that cohesion in the two types of relationships were minimally related to each other, but both correlated with outcome variables. Effects for each type of interpersonal relationship remained significant after controlling for the other type and controlling for trait resilience and combat exposure. The results suggest that the effects of interpersonal cohesion are best understood as reflecting experiences in specific types of relationships rather than general characteristics of people in those relationships.     

Bidding for delayed rewards: Accumulation as delay discounting,delay discounting as regulation,demand functions as corollary

In the accumulation paradigm animals press one manipulandum to accumulate pellets or seconds of access to food, and then press another manipulandum, or run some distance, to collect it. The accumulation may be interpreted as delay discounting, with the animals adjusting the distal amount to compensate for its distance or delay. The amount accumulated before being collected is a linear function of the distance or time that the experimental paradigm stipulates for collecting it. That linear function follows from the Unit‐Price/Unit‐Amount axiom. The inverse of the linear compensation functions gives a delay‐discount hyperbola. The advantages of the accumulation paradigm and analytic framework for delay discounting studies are noted. Compensation functions are then derived from a behavioral regulation model, which generalizes them to contexts where the individual's budget for response cost becomes over‐taxed. In turn, such compensation/regulation models lead directly to representative demand functions. In sum, regulation models provide a theoretical grounding for demand functions, compensation functions, and delay discounting hyperbolas. The parameter that links them is the unit amount k, the slope of the compensation function and of the discount function, the setpoint for consumption in a regulation model, and the ideal quantity consumed at minimal price in a demand analysis.     

Examples of real world engineering ethics problems

Nine examples are presented illustrating the kinds of problems encountered in actual practice by conscientious engineers. These cases are drawn fom the records of the IEEE Ethics Committee, and from the experience of the ethics help-line initiated recently by the Online Ethics Center for Engineering and Science. They range from situations in which companies try to cheat one another to those in which human health and safety are jeopardized. In one case, an engineer learned that even a quiet resignation can prove very costly in a personal sense. Some ways in which professional societies might make ethical practice of engineering somewhat easier are mentioned. An carlier, shorter version of this paper was presented at the International Conference on Ethics in Engineering and Computer Science, Case Western Reserve University, Cleveland, March 21–24, 1999, and can be accessed on line at http://onlineethics.org/cases/unger.html. In all cases described in this paper, the names of individuals and organizations have been suppressed or fictionalized. Professor Unger was Chairman of the IEEE (Institute of Electrical and Electronics Engineers) Ethics Committee (1997–1998).     

The relationship between baseline pupil size and intelligence

Pupil dilations of the eye are known to correspond to central cognitive processes. However, the relationship between pupil size and individual differences in cognitive ability is not as well studied. A peculiar finding that has cropped up in this research is that those high on cognitive ability have a larger pupil size, even during a passive baseline condition. Yet these findings were incidental and lacked a clear explanation. Therefore, in the present series of studies we systematically investigated whether pupil size during a passive baseline is associated with individual differences in working memory capacity and fluid intelligence. Across three studies we consistently found that baseline pupil size is, in fact, related to cognitive ability. We showed that this relationship could not be explained by differences in mental effort, and that the effect of working memory capacity and fluid intelligence on pupil size persisted even after 23 sessions and taking into account the effect of novelty or familiarity with the environment. We also accounted for potential confounding variables such as; age, ethnicity, and drug substances. Lastly, we found that it is fluid intelligence, more so than working memory capacity, which is related to baseline pupil size. In order to provide an explanation and suggestions for future research, we also consider our findings in the context of the underlying neural mechanisms involved.     

Who Is Referred to Mental Health Services in the Juvenile Justice System?

We describe the mental health referral rate among youth in a correction facility, examine how sociodemographic and criminal history characteristics relate to referral, and explore how these variables and diagnostic class differ by referral source. Data were abstracted from case records. The referral rate was low (6%). Non-Latino youth, repeat offenders, and violent offenders were more likely to be referred compared to all detained youth. Referral source also varied by violent offense history and diagnosis type. Future studies examining access to mental health services should take into account a detained youth's sociodemographic, criminal history, and clinical characteristics.     

重症加强监护医学与临床思维

重症加强监护医学的发展史,也是其临床思维的发展史,一个由个体性呼吸衰竭救治观念转化为集群性救治启动了重症加强监护学的建立,它们的发展带动亦受益于其临床思维、动态思维的发展。重症加强监护的实施,引发了医学伦理学新的思考与选择,而新的生物技术革命,必将导致重症加强监护医学及其临床思维的巨大变革。     

医疗过失的法律责任

引起医疗纠纷的事实可分为应由医方承担责任的事实和不应由医方承担责任的事实,只有医方符合法律责任的构成要件－即医疗行为的主体是医疗单位、主体有过失或违反义务的行为、有损害后果、而且主体的行为与损害后果之间有因果关系,才需承担法律责任,以消除只有损害后果医方就要承担法律责任和只有鉴定为医疗事故的才承担法律责任等方面的误区。