妇产科学临床诊疗中的思维

从辩证思维方式在妇产科学临床诊疗中的运用入手,通过多个临床诊疗的实例,说明哲学与医学的共通性。哲学辨证思维的开阔思维方式,可以使妇产科学的临床诊疗活动更加全面和完善,使临床诊断更加精准,制定的治疗方案更加合理,从而尽可能地减少医疗纠纷。     

整形外科的临床治疗决策分析

在生物心理社会医学模式下,以循证医学为基础的共享型临床决策成为主导。整形外科疾病有着诊断容易、治疗方法多样、效果不一、患者年龄小、心理脆弱、大众认知有一定误区等特点,更需要在情感和实践上体现对患者的理解和尊重,真正实现医生患者共同参与的共享型临床决策。     

森田疗法与认知行为疗法的比较分析

规律是客观的,而规则具有主观性,虽然两者本质上不同,但他们又是相关的。从口腔临床医学规则的制定过程来看,我们不难得出结论:口腔临床医学规则的制定要遵循临床医学的一般规律,突出口腔临床医学的特点,并受到我国经济、文化、政治等因素的影响,且随着这些因素的改变而改变,以适应新的环境条件。     

Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial

Outcomes for cognitive-behaviour therapy (CBT) in randomised controlled trials (RCTs) have rarely been compared to those in routine clinical practice. Taking the case of CBT for chronic fatigue syndrome (CFS), we evaluated the results of a successful RCT against those of the same treatment given in the same setting as part of routine practice. Fatigue and social adjustment scores were compared for patients who received CBT for CFS as part of a RCT (N=30) and patients who received CBT as part of everyday clinical practice (N=384). The results in the RCT were superior to those in routine clinical practice. Between pre-treatment and 6-month follow-up, the RCT showed a larger reduction in fatigue and greater improvement in social adjustment than those in routine treatment. The changes in fatigue scores were similar for both groups during treatment but were greater in the RCT between post-treatment and follow-up. Potential reasons for the superior results of the RCT include patient selection, therapist factors and the use of a manualised treatment protocol. Practitioners need to pay particular attention to relapse prevention and ensuring adequate follow-up in addition to encouraging patients to continue with cognitive-behavioural strategies once treatment has ended.     

Infant observation: A range of questions and challenges for contemporary psychoanalysis1

The author attempts to integrate several perspectives within the field of infant observation that reflect the analyst's personal experience as a clinician, as a professor at the analytic institute and as a researcher in the field of psychoanalysis. Can infant observation contribute to analytic technique, theory and training? If so, what would be the nature of such contribution? To answer these questions, the author reviews the literature on infant observation from Freud to the present, highlighting Latin American contributions to this subject. She makes reference to the role of technological innovations, which have allowed videotaping, repeated observations, temporal segmentation and computerized programs, thus giving rise to microanalytic research. This discussion prompts the question about the contributions made by systematic research to clinical practice. To tackle this question, the author presents both a clinical vignette taken from her personal experience, and the current debate on this subject as it appears in the work of Daniel Stern and André Green. Finally, she presents some conclusions that are part of an ongoing debate in the psychoanalytic field.     

协和育才模式与创造性人格

创造性人格是个体创造力的主体部分。协和医科大学的教育模式有助于培养医学生积极的人生态度、高度的自我肯定评价、强烈的内在动机、自主的认知风格以及丰富的情感。在我国高等医学教育改革进程中,普通医学院校应将协和模式与本校实际相结合,加强对医学生创造性人格的培养,增强其创造力,更好地适应国际医学发展的需求。     

浅析当前临床科学决策的几个影响因素

随着循证医学在我国的发展和"医疗举证责任倒置"等相关法律的实施,我国临床医生在进行诊治决策时已逐步向临床科学决策迈进。而防御性医疗、不健全的医疗制度及相关法律等却严重影响着这一科学决策的转变过程。只有有效解决了导致干扰科学决策的各种社会影响因素,如扩大基本医疗保险的覆盖率,实施医疗风险保险制度,提高医务人员认知和职业素质,保障行医安全等,临床科学决策的真正落实就大有希望。     

Exploring the trainees' view of a socio‐political approach within UK clinical psychology

This paper aims to provide preliminary insights into the relationship between clinical psychology and a socio‐political approach known as Critical Community Psychology (CCP). Methodologically, it uses statements about CCP as stimulus material, and utilizes both quantitative and qualitative exploratory techniques, to survey the opinions of 354 UK trainee clinical psychologists. Participants' ratings of the stimulus material and their qualitative comments reveal many positive endorsements of the socio‐political approach. However, themes from the qualitative data raise questions about how socio‐political ideas can be incorporated into clinical practice and highlight uncertainty over the relationship between clinical psychology and politics. Copyright © 2006 John Wiley & Sons, Ltd.     

Human rights and applied psychology

Applied and community psychology necessarily involves the consideration of human rights issues. The problems experienced by many of the clients of applied psychologists result from human rights abuses, the provisions of the Human Rights Act (1998) relate to the everyday practice of applied and community psychologists, and psychologists have a distinctive perspective on human rights. For psychologists, human rights reflect formalized systems for ensuring that people's basic needs are satisfied. Declarations of human rights and legal provisions therefore represent, for psychologists, codifications of how we collectively understand our relationships and social obligations. It is therefore argued that psychologists should positively advocate for the application of psychological science to these issues. Copyright © 2007 John Wiley & Sons, Ltd.     

一期前后联合入路治疗上颈椎畸形

回顾9例因颅底凹陷症合并其它畸形在我科接受一期经口咽齿状突切除、后路枕骨大孔减压、寰枢椎或枕颈融合术治疗的,临床资料,观察该术式对脊髓功能、枕颈部稳定性的影响及其临床疗效。本组术前诊断均为颅底凹陷症合并邻近结构畸形。所有患者均接受前后联合入路手术。末次随访JOA评分15±1分。影像学检查示齿状突残留基底部均位于钱氏线以下,脊髓减压充分,寰枢间、枕颈间植骨均获坚强融合,融合时间平均3．9±1.1个月。因此一期前后路联合手术治疗颅底凹陷症,脊髓减压充分,重建稳定性后骨融合好,治疗效果满意。