加强住院医师临床思维能力培养的探讨

良好的临床思维能力,是住院医师能否成为合格和高水平医生的关键。对住院医师临床思维能力的培养必须明确临床思维的哲学本质和组成的关键要素,并结合住院医师的特点去培养。要注重基本知识、基本理论和基本技能训练,把握正确的恩维程序,运用哲学思想,并以学科综合为中心。     

结节性甲状腺肿手术路径质量管理成效研究

本文通过对比分析临床路径实施前后各项质量相关指标,研究临床路径模式在精细分科部门中结节性甲状腺肿手术患者质量管理的应用成效。结果显示临床路径在质量管理过程中取得显著成效,尤其是在缩短平均住院日方面,但对于费用的控制还有待进一步提高,因此应对实施中的临床路径进行不断地持续改进,为患者提供更优质的服务。     

临床医学教育中的医学哲学

医学哲学是现代医学教育中的重要组成部分,医学科学必须与医学哲学相结合才是未来医学教育的发展方向。在以岗位胜任能力为导向的医学教育转型中,培养医学生的哲学思维无疑是其重要环节之一。为适应全球卫生事业的迅猛发展,医学教育务必在临床思维上进行整合。本文从培养合格医学毕业生的角度出发,阐述了医学与哲学的关系、医学教育中的哲学地位及哲学在临床医学教育中的具体应用。旨在提高医学生的哲学理念,促进现代医学教育的转型发展。     

On no man’s land: Subjective experiences during unresponsive and responsive sedative states induced by four different anesthetic agents

To understand how anesthetics with different molecular mechanisms affect consciousness, we explored subjective experiences recalled after responsive and unresponsive sedation induced with equisedative doses of dexmedetomidine, propofol, sevoflurane, and S-ketamine in healthy male participants (N = 140). The anesthetics were administered in experimental setting using target-controlled infusion or vapouriser for one hour. Interviews conducted after anesthetic administration revealed that 46.9% (n = 46) of arousable participants (n = 98) reported experiences, most frequently dreaming or memory incorporation of the setting. Participants receiving dexmedetomidine reported experiences most often while S-ketamine induced the most multimodal experiences. Responsiveness at the end of anesthetic administration did not affect the prevalence or content of reported experiences. These results demonstrate that subjective experiences during responsive and unresponsive sedation are common and anesthetic agents with different molecular mechanisms of action may have different effects on the prevalence and complexity of the experiences, albeit in the present sample the differences between drugs were minute.     

综合医院开展临床预防服务的可行性

临床预防服务是预防医学的重要组成部分,也是临床医学的重要内容。鉴于慢性非传染性疾病对社会、家庭及个人的负担越来越重,在各级医院尤其综合医院开展临床预防服务,对预防慢性病的发生、发展,降低死亡率、减轻社会、家庭负担,将起到事半功倍的作用,产生深远影响。     

On teaching psychoanalysis

Teaching psychoanalysis is no less an art than is the practice of psychoanalysis. As is true of the analytic experience, teaching psychoanalysis involves an effort to create clearances in which fresh forms of thinking and dreaming may emerge, with regard to both psychoanalytic theory and clinical practice. Drawing on his experience of leading two ongoing psychoanalytic seminars, each in its 25th year, the author offers observations concerning (1) teaching analytic texts by reading them aloud, line by line, in the seminar setting, with a focus on how the writer is thinking/writing and on how the reader is altered by the experience of reading; (2) treating clinical case presentations as experiences in collective dreaming in which the seminar members make use of their own waking dreaming to assist the presenter in dreaming aspects of his experience with the patient that the analytic pair has not previously been able to dream; (3) reading poetry and fi ction as a way of enhancing the capacity of the seminar members to be aware of and alive to the effects created by the patient's and the analyst's use of language; and (4) learning to overcome what one thought one knew about conducting analytic work, i.e. learning to forget what one has learned.     

Respecting the LDS/Mormon Minority on Campus: College Students’ Attitudes Toward Latter‐Day Saints

Members of the Church of Jesus Christ of Latter‐Day Saints remain a minoritized and marginalized population in the United States at large, a pattern mirrored on the majority of college and university campuses across the United States. This study addresses how social identities, institutional contexts, and intergroup dynamics within the postsecondary education environment contribute to cultivating college students’ attitudes toward LDS/Mormons and Mormonism. Using data collected from 13,584 college students attending 52 institutions across the country, the study employs multilevel modeling to examine these relationships. The analyses highlight the importance of productive interreligious contact in a supportive institutional context for shaping out‐group attitudes. Affirming the interplay between social identity and intergroup contact, effects on out‐group attitudes vary to some extent by religion/worldview. Implications for research and practice are discussed.     

临床医生对患者参与临床决策的可行性调查与分析

在临床决策中,决策者将面临包括生物、心理、社会方面的更多信息。同时随着医疗费用的增长、医学科学的不确定性、患者知识的提高、参与意识的增强、因特网的普及等促使临床决策更加困难。为了更好地促进患者参与临床决策,提高医疗服务质量,我们采用自拟问卷调查表随机对273名四川大学华西医院的临床医生进行调查。了解临床医生对患者参与治疗决策的困难与态度,分析影响患者参与临床决策的因素,为促进医患共享临床决策提供循证依据。     

腹腔肿块外科处理的临床决策

临床经常会面对诊断、来源、性质不清的腹腔内肿块。腹腔内肿块是临床常见的病症之一,大多需要外科手术。如何合理应对、妥善处置、科学决策是临床医师对本病诊治的要求和不懈追求。诊断的过程中,依靠详尽的病史、细致的体格检查、恰当的辅助检查,并进行综合的分析以及逻辑思维,做出正确的鉴别和诊断,以解决是否为腹腔内肿块;而后,尽快确定肿块的部位及性质,确定处理的方法和原则,制订详尽的手术方案和步骤。