基于意定监护制度对预先医疗指示的思考

鉴于中国大陆地区尚未建立预先医疗指示制度,为保证患者自主权,尊重其医疗意愿,可通过《民法总则》规定的意定监护制度实现预先医疗指示,其理由在于二者存在相同的法理基础、双向交叉的概念内涵以及现实实践基础。但依据现有法律规制实践过程中仍然存在不足,包括协议缔结的具体规定不明确、生效条件模糊、监督机制欠缺等问题。为解决这些问题,考虑完善相关法律规定,明确主体资格,制定合理的缔结程序,严格限制生效条件,建立监督机制等。     

新疆生产建设兵团某公立医院医疗纠纷赔付率影响因素分析

通过探索医疗纠纷赔付现况及其影响因素,为改善医患关系、控制医疗纠纷赔付率提供建议,对新疆生产建设兵团某公立三甲医院2002年~2021年发生的医疗纠纷案例共423件进行分析。结果显示医方是造成医疗纠纷赔付的主要原因,占比82.51%,非条件二分类Logistic回归分析表明：骨科(OR=4.670, 95%CI: 1.522~14.322)、普外科(OR=4.910, 95%CI: 1.529~15.768)、外科(其他)(OR=3.139, 95%CI: 1.144~8.610)、医技科(OR=20.490, 95%CI: 3.594~116.804) 为医疗纠纷赔付率的独立危险因素,协商(OR=0.336, 95%CI: 0.147~0.768)途径为保护因素(P＜0.05)。医院要引入医调委解决医疗纠纷案件,对医务人员进行管理、培训,重点关注骨科、普外科、医技科等医疗纠纷赔付率较高的科室。

     

Relationship between anxiety and dyspnea on exertion in patients with chronic obstructive pulmonary disease

Abstract

Dyspnea limits exercise in patients with chronic obstructive pulmonary disease (COPD) and is known to induce anxiety. Little is known whether anxiety contributes to exercise-induced dyspnea, which in turn might influence the outcome of diagnostic tests. The aim of the present study was to examine the relationship between general anxiety and dyspnea on exertion in patients with COPD.

Ninety patients with stable COPD participated; 44 men, mean age 61 (standard deviation (SD) 10.4), and mean forced expiratory volume in 1 second (%pred.) 40.5 (SD 16.9). All participants performed pulmonary function tests and an incremental cycle ergometry. The Modified Borg Scale was used to measure the level of dyspnea on exertion. Anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale. Data were analyzed using Spearman's correlations and multivariate regression. Dyspnea on exertion was correlated with general anxiety (r=.31), age (r=–.30), and exercise capacity (r=.27). Regression analysis showed that general anxiety was associated with dyspnea on exertion, adjusted for sex, age, baseline dyspnea, and exercise capacity. Consequently, it is reasoned that results of exercise training and activities in daily living may be influenced negatively by anxiety-worsened dyspnea. Attention should be given to anxiety management in patients with COPD to optimize exercise training.     

RECENT TRENDS IN RESPONSE TO CHILD VICTIMIZATION

Abstract

This chapter serves as an introduction to the many roles of health care professionalsin the assessment, care, and treatment of child victimization. It concentrates on those professionals caring for the physical health of victims of child abuse and neglect, although there are many similarities between child maltreatment and other family violence victims. In reviewing the health impact of maltreatment and the historical contributions of health care professionals, it discusses the roles that health care disciplines play in clinical care, training, research, and advocacy and their interaction with the community's child welfare, legal, and criminal justice systems.     

Trauma Exposure and Health: A Review of Outcomes and Pathways

A growing body of literature has established robust relations between trauma and a variety of adverse physical health outcomes. In both retrospective and prospective research, adults with a history of self-reported or court-substantiated maltreatment report significantly more health concerns than those without maltreatment histories, in both clinical and community samples, whether health problems are self-reported or physician-diagnosed. Two pathways by which poor health outcomes are theorized to occur include the biological pathway, which largely implicates severe stress and subsequent dysregulations in central stress-response systems as the underlying cause of health problems, and the behavioral pathway, which suggests that health risk behaviors are largely responsible for the relations between trauma and health. This article reviews the research evaluating the relations between various types of trauma, particularly physical and sexual abuse in childhood, and three such health outcomes: pain, gastrointestinal disorders, and cardiovascular disease. Evidence to support the biological and behavioral pathways is also reviewed.     

What Do Medical Providers Need to Successfully Intervene with Intimate Partner Violence?

ABSTRACT

Increasingly, medical providers (physicians and mid-level providers) rely on research evidence to inform their medical practice. In order for medical providers to accept their role in diagnosing and intervening with IPV, they need clinical tools and institutional support. This paper explores the tools (prevalence rates, screening questions, intervention strategies) and support (educational, institutional, professional, research) needed to assist medical providers in successfully intervening with IPV. It also looks at the importance of guidelines and expert consensus panel statements to help establish best clinical practices when direct research evidence is lacking or conflicting.     

The Effect of Differing Measuring Methods on the Relationship of Motives

Over the past 30 years, few approaches to the study of motivation have generated the volume of research as have studies of the need for achievement, need for affiliation, and need for power. Yet few studies have been concerned with the interdependency of these motives. The goals of the present paper were to determine whether these motives are interdependent, and to compare two different measures of these needs. Ninety men and women from introductory psychology classes served as the subjects. They were administered the TAT and the Edwards Personal Preference Schedule test to determine the strength of these motives. The findings suggest that these psychogenic needs are not independent of each other. While the present results show no significant correlation between these needs among men, a significant one emerges for women. There were also significant correlations between the two techniques of measuring the motives, a test involving fantasy materials and a “self report” questionnaire.     

Determining Activity of the Autonomic Nervous System from Measurements of Autonomic Change

Three hundred and fifty female high school students observed an outcome of a hypothetical interpersonal dyadic interaction. The outcome was either a suicide (serious outcome) or a half-hearted suicide attempt (less serious outcome). In one condition, one of the actors was presented as intentionally performing certain actions which he or she knew could cause the other actor to attempt or actually commit suicide. In the other condition, the perpetrator acted in an unintentional manner. Ss' identifications with either the victim or the perpetrator were also manipulated. Furthermore, Ss were independently classified as to whether they considered circumstances (C) or intentionality (I) as the important factor in attributing responsibility. C-attributers identifying with the victim assigned more responsibility to the perpetrator for the serious outcome. C-attributers identifying with the perpetrator assigned more responsibility to that perpetrator in the less serious condition. Predictions for I-attributers were also confirmed.     

Treatments Addressing Pain-Related Fear and Anxiety in Patients with Chronic Musculoskeletal Pain: A Preliminary Review

Abstract

This review covers the current cognitive behavioural treatments available to address fear-avoidance beliefs in patients with chronic musculoskeletal pain (CMP). Four types of treatment protocols were identified for inclusion in the review: (a) graded in vivo exposure (GivE); (b) graded activity (GA); (c) acceptance and commitment therapy (ACT); and (d) mixed cognitive behavioural protocols. Most of the research suggests that GivE and ACT result in the best outcomes for treating fear-avoidance beliefs in patients with CMP. There is also a readily apparent paucity of research from North America; indeed, most of the available studies were conducted in the Netherlands and Scandinavia. This relative absence of North American research raises potentially important questions about the role of compensation status and access to care, which differ between countries, on treatment outcome. Implications and directions for future research are discussed.     

Fear of Pain is Elevated in Adults with Co‐Occurring Trauma‐Related Stress and Social Anxiety Symptoms

The aim of this study was to determine whether fear of pain and related fear constructs are elevated in people with co‐occurring trauma‐related stress and social anxiety symptoms relative to people with 1 or neither of these conditions. Eighty students were selected from a larger sample and divided into 4 equal groups comprising those with both high trauma‐related stress and social anxiety symptom scores (TRS/SAS), only high trauma‐related stress symptom scores (TRS), only high social anxiety symptom scores (SAS), or neither (N). Results indicated that the TRS/SAS group had significantly higher scores on all fear of pain measures, anxiety sensitivity, and illness/injury sensitivity than any other group, even when level of current pain was included as a covariate. These findings suggest that people with co‐occurring trauma‐related and social anxiety symptoms are most likely to be fearful of pain and to thereby be at increased risk of developing chronic and disabling pain. Implications for future research and treatment are discussed.