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781.
如何提高临床医学生与患者之间沟通的能力 总被引:17,自引:1,他引:16
正常有序的医疗活动应以良好的医患沟通为基础,要从根本上处理好医患关,首先要从培养临床医学生与患者之间的沟通能力入手,多数医学生在进入临床实习时都因紧张而不知道应该如何与患者沟通,因此培养医学生与患者间良好的沟通能力是当前迫切需要解决的问题。 相似文献
782.
祖述宪 《医学与哲学(人文社会医学版)》2007,28(4):6-9
把无效的治疗误认为有效,不仅在大众中非常普遍,而且很多医生也常如此。造成这种疗效假象有许多原因,主要由于疾病的自愈或自发缓解、药物和治疗的安慰效应、缺乏严格的评价疗效标准以及诊断不确实,以及把良性疾病误诊为严重或恶性疾病所造成的。对传统医疗的信仰也是原因之一。因此,对任何药物或医疗的效果必须进行严格的随机对照临床试验,并且得到同行的检验和公认。 相似文献
783.
Cognitive predictors of single-digit and procedural calculation skills and their covariation with reading skill 总被引:1,自引:0,他引:1
This study examined the extent to which children's cognitive abilities in kindergarten and their mothers' education predict their single-digit and procedural calculation skills and the covariance of these with reading skill in Grade 4. In kindergarten, we assessed children's (N=178) basic number skills, linguistic skills, and visual attention. In Grade 4, we assessed their calculation and reading skills. Data on children's cognitive ability at 5 years of age and their mothers' level of education were also collected. The results showed that both of the core components of calculation, single-digit and procedural calculation, as well as their covariance with reading, were predicted by unique cognitive factors. Fluency in single-digit calculation and text reading shared an underlying cognitive process, that is, the ability to fluently retrieve verbal or visual-verbal associations from long-term memory. In contrast, procedural calculation was predicted not only by single-digit calculation but also by mother's education and conceptual knowledge of numbers. Overall, the results suggest that a multicomponential approach, including a hierarchical relation among various components, is fruitful when trying to understand the development of mathematical skill and its covariation with reading. 相似文献
784.
A community, juvenile prostitution rehabilitation programme in Bogotá, Colombia, South America is described; and beliefs and values of the residents were explored. Multiple sorting procedures and multi‐dimensional scaling analysis elicited qualitative, structured, self‐report data, and investigated cognitive constructs. Participants discriminated between belief‐statements along two global dimensions: street‐life and prostitution; and rehabilitation. These were comprised of qualitatively different elements. Clinical implications for interventions with this group and the rehabilitation programme are discussed. Copyright © 2007 John Wiley & Sons, Ltd. 相似文献
785.
McAllister M Payne K Nicholls S MacLeod R Donnai D Davies LM 《Journal of genetic counseling》2007,16(1):71-83
Outcome measurement in clinical genetics is challenging. Outcome attributes used currently have been developed by service
providers or adapted from measures used in other areas of healthcare. Many of the ‘patients’ in clinical genetics are healthy
but at risk of developing or transmitting a condition. Usually no pharmacological or surgical treatment is offered, although
information-giving is an objective of most consultations. We argue that services should be evaluated on the basis of how well
they alleviate the effects of disease, from a patient perspective. This paper describes a qualitative study using seven focus
groups with health professionals, patients and patient representatives. Social and emotional effects of genetics diseases
were identified. Some differences emerged between the effects identified by health professionals and those identified by patients.
These findings will be used to inform the evaluation of existing outcome measures and develop robust measures of outcome for
clinical genetics services. 相似文献
786.
This study examined the internal consistency, diagnostic efficiency, and validity of selected scales of the Millon adolescent clinical inventory (MACI; Millon et al., Manual for the Millon Adolescent Clinical Inventory, National Computer Systems, Minneapolis, MN, 1993). 241 psychiatrically hospitalized adolescents were administered the MACI and a battery of established self-report measures and a multidisciplinary team independently assigned DSM-IV psychiatric diagnoses at the time of discharge. The internal consistency of MACI scales ranged from 0.71 to 0.93. Conditional probabilities (sensitivity, specificity, positive predictive power, and negative predictive power) were calculated for selected disorders using independently generated clinical diagnoses as the standard. The diagnostic efficiencies for the selected scales were variable, with adequate performance for predicting classes of diagnoses but not for specific diagnoses. The MACI showed good criterion validity for most disorders, with participants with a clinical diagnosis having a significantly higher corresponding MACI scale score than participants not assigned that diagnosis. Concurrent validity, tested by correlating MACI scale scores with those of relevant, validated measures, was generally good. The MACI appears to be a psychometrically sound self-report instrument and appears valuable as a screening instrument for many problems found in adolescent psychiatric inpatients. 相似文献
787.
Clinical Implications and Methodological Challenges in the Study of the Neuropsychological Correlates of Cannabis,Stimulant, and Opioid Abuse 总被引:1,自引:0,他引:1
Verdejo-García A López-Torrecillas F Giménez CO Pérez-García M 《Neuropsychology review》2004,14(1):1-41
Chronic consumption of several drugs of abuse (cannabis, stimulants, opioids) has been associated with the presence of neuropsychological impairments in a broad range of functions. Nevertheless, in recent years neuropsychological research on substance abuse has focused on the study of impairments in the executive functions linked to the prefrontal cortex and their influence on the personality, cognitions, and behaviors of the substance abusers. The aim of our review is, first, to summarize the main neuropsychological impairments shown by classic studies, as well as these new discoveries in executive functioning; second, to consider the mediating role of neuropsychological status on treatment outcomes and analyze the impact of these impairments in clinical practice with drug addicts; and third, to review the principal methodological challenges associated with research in the field of the neuropsychology of substance abuse. We also highlight the convenience of intervening in those functions most relevant to the abusers' persistence in consumption and risk of relapse. 相似文献
788.
Vrhovac B 《Science and engineering ethics》2004,10(1):81-93
The Helsinki Declaration is the ‘gold standard’ — a directive, not a law, on how to conduct controlled studies in humans in
conformity with ethical principles. In spite of many discussions about their unsuitability some articles have remained unchanged
in the most recent (sixth) revision of the Declaration. The demand to use “the best treatment” excludes use of placebo in
the control group and presents an obstacle to the scientific evaluation of a number of drugs and treatments in general. The
use of placebo is justified whenever its use does not cause irreversible damage or considerable suffering to the well informed
patient. It must be, is, and will be used in the controlled clinical trials of treatments of a great number of diseases especially
those which have a tendency to spontaneous improvement, even healing, or have a pronounced psychological component
An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research
Today,” held in Warsaw, Poland on 12–13 April, 2003. 相似文献
789.
Puzyński S 《Science and engineering ethics》2004,10(1):135-142
The paper presents major ethical, legal and methodological problems related to the use of placebo in mental disorders, especially
in depression. It is pointed out that although authoritative groups of experts and numerous publications in the field of psychopharmacology
indicate advisability of the double blind design with placebo in clinical trials of antidepressants, in recent years there
have been more and more voices questioning legitimacy of this method. Objections of an ethical nature are raised, and reliability
of this approach is put into doubt from the methodological viewpoint. These issues are discussed in more detail in the paper.
Available alternative solutions should be implemented in psychotropic drug studies. The author shares these objections and
doubts of an ethical nature, and believes that the placebo procedure is not a necessity in clinical trials of antidepressants.
An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research
Today,” held in Warsaw, Poland on 12–13 April, 2003. 相似文献
790.
Miller FG 《Science and engineering ethics》2004,10(1):157-166
Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken, and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent. 相似文献