扩展临床路径内涵 推进双向转诊开展

文章概括我国现阶段双向转诊状况及其存在的问题和问题产生原因,并在临床路径启示下,对寻找做好双向转诊工作的途径进行思考,探索全面长期深入开展双向转诊工作具体做法,论述了扩展临床路径内涵对推进双向转诊工作开展的意义,规范双向转诊,旨在形成推进双向转诊长效机制。     

Clinical Geropsychology: Implications for Practice in Medical Settings

Older adults are a rapidly growing segment of the population, who have high rates of chronic illness and who utilize health care resources heavily. Psychologists must become better prepared to work with older patients in geriatric settings, including geriatric assessment units, memory disorders clinics, and nursing homes. In addition, all psychologists will increasingly encounter older patients in environments such as primary care clinics, rehabilitation settings, and disease management programs focusing on problems that are prevalent in older patients (e.g., cancer, diabetes). Suggestions are offered for adaptation of usual clinical practice to address the special needs of older patients and their families, and recommendations made for advancing and expanding the practice of clinical geropsychology.     

临床药师参与临床决策的有限理性分析

为了提高临床药师工作质量,在有限理性视阈下探析临床药师工作的特点。临床药师参与临床查房、疑难病例讨论、药品不良反应分析与处置、药物重整、患者用药教育等临床决策具有一定的理性特性,但是这种理性属于有限理性。医疗机构决策者应该重视培养临床药师的思维活动过程,重视临床药师投入的沉淀成本;同时,临床药师自身要提高临床决策的满意标准和重视临床决策目的的层级结构关系。通过以上的做法对临床药师队伍发展有积极的促进作用。

     

Conflict of interest and its significance in science and medicine: a view from Eastern Europe

Conclusions  Continued scientific and medical progress in Central and Eastern Europe depends on the development of an atmosphere that is conducive to implementing the changes that are necessary to bring better health and longer lives for everyone. Privatization and commercialization are threatening the objectivity of clinical research and the availability of health care because uncontrolled market mechanisms focused on profit are nurturing conflict of interest that generate bias and unreliability into research and medicine. Changes are needed that address the following:

Prevalence of auditory verbal hallucinations in a general population: A group comparison study

The present study was specifically designed to investigate the prevalence of auditory verbal hallucinations (AVH) in the general population, and sought to compare similarities and differences regarding socio‐demographics, mental health and severe life events between individuals who have never experienced AVH with those who had. The study also aimed to compare those who sought professional help for their experience of AVH with those who had not sought help. Through a postal questionnaire, 2,533 participants ages 18 and over from a national survey completed the Launay‐Slade Hallucinations Scale and other measures examining AVH characteristics and other areas related to AVH. In total, 7.3% of the sample reported a life‐time prevalence of AVH. Those with AVH were more likely to be single and unemployed, reported higher levels of depression and anxiety, and experienced a higher number of severe life events compared with those without AVH. Only 16% of those who experienced AVH in the general population sought professional help for these experiences. Compared to those who did not seek professional help, participants that had were more likely to experience AVH with a negative content, experience them on a daily basis, undergo negative reactions when experiencing AVH, and resist AVH. In conclusion, the prevalence of AVH was found to be relatively high. The results also revealed higher levels of reduced mental health for individuals who sought professional help, followed by those who did not, compared with those who had never experienced AVH.     

Experiences of Countertransference: Reports of Clinical Psychology Students

While historically linked with psychoanalysis, countertransference is recognised as an important component of the experience of therapists, regardless of the therapeutic modality. This study considers the implications of this for the training of psychologists. Fifty‐five clinical psychology trainees from four university training programmes completed an anonymous questionnaire that collected written reports of countertransference experiences, ratings of confidence in managing these responses, and supervision in this regard. The reports were analysed using a process of thematic analysis. Several themes emerged including a desire to protect or rescue clients, feeling criticised or controlled by clients, feeling helpless, and feeling disengaged. Trainees varied in their reports of awareness of countertransference and the regularity of supervision in this regard. The majority reported a lack of confidence in managing their responses, and all reported interest in learning about countertransference. The implications for reflective practice in postgraduate psychology training are discussed.     

临床共情与护理技术结合:人性化的护理

临床共情是一种能体验患者内心世界的能力,通过患者的言语和非言语表达,觉察和认识患者情感和情绪需求,并对其做出恰当的回应.临床共情具有科学的理论和实践基础,具有缓解患者心理上的痛苦,改善护患关系,促进患者康复等作用.在当今复杂的医疗环境下,务必要重视共情培养,适时运用临床共情.然而,我们强调临床共情的重要作用,并不能忽视护理技术的根本作用,根除躯体上的病变仍有赖于护理技术的有效性.在临床护理实践中,坚持共情与护理技术的有机结合,推进人性化的护理构建.     

临床医学中人性化医疗的非显性误区辨析

随着现代医疗技术的迅猛发展,人们在享受高新技术提供服务的同时,却对临床医学存在的非人性化趋势提出越来越多的质疑,因此,需要对医学目的和价值进行重新审视。本文阐述了人性化医疗中存在的某些非显性误区,这是医学人文削减的主要内在原因,面对技术与人文之间的矛盾关系,出路在于医疗技术的人性化方向,赋予非人性化手段以人性化关怀,在探索人性化的医疗手段中实现医疗的人性化复兴。     

医师职业素养评测体系构建的研究进展

随着我国社会经济的发展,医疗体制的改革,医师职业素养的培养成为当今医疗体制下医学在校教育、住院医生培养、医疗卫生管理中必须关注的内容。目前国外对医师职业素养的培养做了大量的工作,也取得了较好的效果,但是对于职业素养的培养不仅需要理论教学的改革,更需要相应评估机制的建立。本文对国外医师执业素养评估的最新进展进行介绍,分析各种方法的优劣,以期为国内医学教育建立统一的、具有广泛公认度的测评体系提供参考。     

Childhood Sexual Abuse and Intimate Partner Violence in a Clinical Sample of Men: The Mediating Roles of Adult Attachment and Anger Management

This study examined the association between men’s experience of childhood sexual abuse and later perpetration of intimate partner violence, considering the roles of attachment insecurity and poor anger regulation. The sample was 302 Canadian men undergoing counseling for relationship difficulties or aggression. They completed questionnaires assessing childhood sexual abuse, the two dimensions of attachment insecurity (anxiety and avoidance), anger regulation processes, physical and psychological aggression, and social desirability bias. Path analyses showed that men who experienced childhood sexual abuse scored higher on attachment anxiety, which in turn was associated with aggressive behaviors directly and through four anger-related variables (trait anger, anger-in, anger-out, and low anger control). Attachment-related avoidance predicted psychological aggression, but not physical aggression, through men’s trait anger and anger-in.