体外循环技术临床研究和应用的进展

体外循环技术因心血管外科的发展需要而产生,又随着心血管外科的发展而不断进步,并且推动着心血管外科向更高深的领域开拓;与此同时,体外循环的仪器设备,也随着科学技术的发展,在不断地研发和更新换代,为临床上利用体外循环技术提供了更安全、更有效的保障,因此,其应用范围几乎渗透发展到临床各个领域,应用前景相当广阔。     

试论营养支持在中晚期癌症患者治疗中的理性选择

几乎所有中晚期癌症患者治疗中都会或多或少应用到临床营养支持治疗,适时、正确地应用对部分中晚期患者极具积极意义,而选择性地对一部分晚期患者有限应用甚至放弃,可能是更为理性的选择。从癌的本质出发,科学地应用营养不良筛选及评定方法,使临床营养支持治疗成为中晚期癌症患者的真正需要。     

老年病人心理干预的语言艺术

恰当运用临床医学语言与沟通技巧,对老年病人实施心理干预,既是一种重要的治疗手段,也是医德的重要组成部分,更是一门充满人文关怀的医疗艺术.     

医学生实习与患者就医间矛盾调和

患者就医希望得到经验丰富的医生诊治,而经验丰富的医师往往由无经验的实习医师通过以牺牲患者利益为代价成长起来的.随着医师法的实施和病人要求的提高,实习医师与患者间的利益冲突构成的这一矛盾更加突出.为化解矛盾,通过提高实习医师业务素质和道德素质,增强临床老师责任心等一系列措施,提高病人对医院满意程度,使实习医师圆满完成实习任务.     

“Transferring” and transference

This paper is part of my research into psychotic transference and is also related to the psychotic aspect of any adult or infantile patient in analysis. In my research, I studied the origin of the concept of transference in Charcot's time before Freud, and the transformation of this concept in psychoanalysis. Freud thought that psychotic patients were not able to establish a transference relationship, but some of his early papers show the opposite. In fact, Freud himself and then several other analysts were able to develop a personal experience regarding the possibility of contact and transferring feelings and delusional experiences in a therapeutic context – individual, group, or institution. I provide some clinical examples in this paper, as well as some theoretical, personal views regarding intrapersonal and interpersonal transference. Like Freud and Melanie Klein, I believe that transference starts with life, but that in psychoanalysis it has a particular meaning.     

Foreign‐Born Therapists: How Acculturation and Supervisors' Multicultural Competence Are Associated With Clinical Self‐Efficacy

The authors examined the associations between acculturation, supervisors' multicultural competence, and clinicians' self‐efficacy in a sample of 153 immigrant therapists currently practicing in the United States. Participants completed a demographic questionnaire and 3 additional questionnaires that examined their levels of acculturation, perceived supervisors' multicultural competence, and clinical self‐efficacy. Results suggested that perceived prejudice, not level of acculturation, was significantly associated with foreign‐born therapists' clinical self‐efficacy. Perceived supervisors' multicultural competence was significantly associated with therapists' clinical self‐efficacy. Recommendations for supervisors working with foreign‐born therapists are provided. Los autores examinaron las asociaciones entre aculturación, competencia multicultural de los supervisores y autoeficacia de los profesionales clínicos en una muestra de 153 terapeutas inmigrantes actualmente en activo en los Estados Unidos. Los participantes completaron un cuestionario demográfico y tres cuestionarios adicionales que examinaron sus niveles de aculturación, la competencia multicultural percibida de sus supervisores y la autoeficacia clínica. Los resultados sugieren que los prejuicios percibidos, no el nivel de aculturación, están asociados de forma significativa con la autoeficacia clínica de los terapeutas nacidos en el extranjero. La competencia multicultural percibida de sus supervisores está asociada significativamente con la autoeficacia clínica de los terapeutas. Se proporcionan recomendaciones para supervisores que trabajan con terapeutas nacidos en el extranjero.     

From question-behaviour effects in trials to the social psychology of research participation

The ‘question-behaviour effect’ (QBE) has attracted much recent attention within health psychology, where it has also been referred to as the ‘mere measurement’ effect. There are other conceptualisations of similar phenomena in related disciplines. This paper explores the implications of the QBE for the safety of inferences about intervention effectiveness within the context of randomised controlled trials evaluating health behaviour change interventions. It draws attention to poorly understood mechanisms by which bias is introduced with conventional thinking about trial design and analysis. The threat to valid inference on intervention effectiveness posed by the QBE applies even when its effects are small and regardless of the specific content of the QBE. The nature of the resulting bias does not fit well within existing bias classification schemes, such as that proposed by the Cochrane Collaboration. The QBE is one possible consequence of research participation and it is suggested that the social psychology of research participation is very much underdeveloped. Possible future directions for health psychology research in this area are considered.     

Young People's Experiences of Participation in Clinical Trials: Reasons for Taking Part

Given the lack of knowledge about safety and efficacy of many treatments for children, pediatric clinical trials are important, but recruitment for pediatric research is difficult. Little is known about children's perspective on participating in trials. The purpose of this study was to understand the experiences and motivations of young people who took part in clinical trials. This is a qualitative interview study of 25 young people aged 10–23 who were invited to take part in clinical trials. Interviews were audio or video recorded and analyzed using framework analysis. Young peoples' motivations were both personal benefit and helping others. Both incentives appeared to be more complex than expected. We introduce the terms “network of exchange” and “intergenerational solidarity” to describe these motivations. To improve recruitment, professionals should be more open about research opportunities, provide better information, and give young people feedback after the trial has ended.     

Looking for Trouble: Preventive Genomic Sequencing in the General Population and the Role of Patient Choice

Advances in genomics have led to calls for developing population-based preventive genomic sequencing (PGS) programs with the goal of identifying genetic health risks in adults without known risk factors. One critical issue for minimizing the harms and maximizing the benefits of PGS is determining the kind and degree of control individuals should have over the generation, use, and handling of their genomic information. In this article we examine whether PGS programs should offer individuals the opportunity to selectively opt out of the sequencing or analysis of specific genomic conditions (the menu approach) or whether PGS should be implemented using an all-or-nothing panel approach. We conclude that any responsible scale-up of PGS will require a menu approach that may seem impractical to some, but that draws its justification from a rich mix of normative, legal, and practical considerations.