转化医学应用现状及其困境分析

转化医学的理念已经蓬勃发展起来,但对大多数处于临床一线的医生而言,却产生了较多困惑:基础医学与临床医学之间仍相互脱节,许多先进的基础医学研究难以为临床实践所用,基础医学的先进成果向临床的转化难以实现.因此,对于转化医学理念的提出,应有所反思,使转化医学的价值得以充分地发挥.     

高血压病患者双向转诊临床路径的效果效益评价

为了评价高血压病患者双向转诊临床路径的效果效益,采用病例查阅、专家咨询、现场考察、试点研究、个人访谈等方法,评价试验组和对照组高血压患者双向转诊临床路径的效果效益.结果显示,试验组首次就诊时间和再次就诊率与对照组间差异有统计学意义(P＜0.05);两组间医疗费用和对医护人员服务态度满意率差异有统计学意义(P＜0.05);两组间治疗效果差异无统计学意义(P＞0.05),提示实施高血压病患者双向转诊临床路径有很好的社会和经济效益.     

临床医师医学人文认知情况的问卷分析——大连医科大学、哈尔滨医科大学、南京医科大学、河北医科大学、重庆医科大学联合调查之一

调查5个城市24所附属或教学医院的1 836名在职医师对医学人文的认知情况,结果表明,从总体来看,医学人文的问题已经开始引起医师们的重视,医师对医学人文的诸多问题有相当清楚的认识,医生们认为医学人文的核心思想是关爱、敬畏、呵护生命;实现医疗人性化的目标,更为重要的是临床诊疗实践中的人性化;在医院管理中落实医疗人性化,最主要的是优化行政管理,为医师们减轻压力;医学人文教育存在的最主要问题是医学人文教育与临床实践脱节;等等.     

整合临床医学的必要性、可行性及途径——以睡眠呼吸暂停防控为例

长期以来以专科划分为主的医疗发展方式确实促进了现代医学的进步.然而,人是一个整体不应该被割裂对待.所以,这种医学发展趋势应该加以控制,否则必然会阻碍医学事业的健康发展.另外,如果只关注局部治疗想要取得突破已经越来越难.因此,整合临床医学势在必行.本文分别从阻塞性睡眠呼吸暂停的病因、临床表现(包括合并症)及诊断和治疗三个方面阐述了只有全面进行医学整合才能提高阻塞性睡眠呼吸暂停的整体防控水平.     

关于内科临床技能培训教学课程设置的探讨

通过对参加内科临床技能培训的大连医科大学2007级、2009级五年制及七年制临床医学专业学生进行问卷调查及客观结构化临床考试（OSCE）,探讨内科临床技能培训课程的学时及课程内容等设置.100%的学生认为有开设临床技能培训课的必要,50%以上的学生认为在大学4年级开设本课程较合适,50%以上的学生认为12学时的设置较合理,80%以上的学生认为应每4人共用一名模拟人.OSCE证实毕业前12学时培训组成绩优于实习前8学时组.     

慢性阻塞性肺疾病急性加重期临床路径应用效果评价

评价临床路径管理在慢性阻塞性肺疾病急性加重期（AECOPD）的应用效果。通过采用回顾性调查,比较进入临床路径（路径组）和没有进入临床路径（对照组）两组患者在住院费用、住院时间及治疗效果3项指标上的差别。结果显示实施临床路径患者（路径组）的平均住院费用、平均住院日等指标均有不同程度的下降,而治愈率有所上升。从而得出临床路径在AECOPD病种的应用能够规范医疗行为,提高医疗护理质量的结论。     

Nonrelativist Ethical Standards for Goal Setting in Psychotherapy

A number of authors have commented on the topic of mandated reporting in cases of suspected child maltreatment and the application of this requirement to researchers. Most of these commentaries focus on the interpretation of current legal standards and offer opinions for or against the imposition of mandated reporting laws on research activities. Authors on both sides of the issue offer ethical arguments, although a direct comparison and analysis of these opposing arguments is rare. This article critically examines the ethical arguments made by authors on both sides of the debate. The conclusion is reached that researchers should be mandated reporters of child maltreatment because the current arguments do not justify their exclusion from current ethical and legal standards. The author makes recommendations for the ethically responsible conduct of research in regard to this topic and legal implications are discussed.     

The Effective Treatment of Juveniles Who Sexually Offend: An Ethical Imperative

This article raises serious concerns regarding the widespread use of unproven interventions with juveniles who sexually offend and suggests innovative methods for addressing these concerns. Dominant interventions (i.e., cognitive-behavioral group treatments with an emphasis on relapse prevention) typically fail to address the multiple determinants of juvenile sexual offending and could result in iatrogenic outcomes. Methodologically sophisticated research studies (i.e., randomized clinical trials) are needed to examine the clinical and cost-effectiveness of cognitive-behavioral group interventions, especially those delivered in residential settings. The moral and ethical mandate for such research is evident when considering the alternative, in which clinicians and society are willing to live in ignorance regarding the etiology and treatment of juvenile sexual offending and to consign offending youths to the potential harm of untested interventions. Encouraging signs of a changing ethical climate include recent federal funding of a randomized clinical trial examining treatment effectiveness with sexually offending youths and the introduction of separate (i.e., developmentally informed) clinical and legal interventions for juvenile versus adult sexual offenders.     

Unique Ethical Concerns in Clinical Trials Comparing Psychosocial and Psychopharmalogical Interventions

In recent years, there has been a particular emphasis placed on conducting randomized controlled trials (RCTs) that compare the relative efficacy of psychosocial and pharmacological interventions. This article addresses relevant ethical considerations in the conduct of these treatment trials, with a focus on RCTs with children. Ethical concerns, including therapeutic misconception, treatment preference, therapeutic equipoise, structure of treatments, and balancing risks versus benefits, are introduced through a clinical scenario and discussed as they relate to psychotherapy versus medication RCTs. In each case, suggestions are made for researchers seeking to minimize the impact of these ethical concerns on research participants.     

Treatment Outcome Studies With Children: Principles of Proper Practice

This article addresses ethical issues in conducting randomized clinical trials (RCTs) with youth. Ethical considerations that occur prior to treatment (matters of research design, the risk–benefit ratio, issues concerning assent/consent, the influence of payment for participation), during treatment (issues of privacy, protocol adherence, premature termination), and following treatment (needs for posttreatment referrals and/or follow-up contacts, archiving of treatment data) are reviewed. Recommendations, based on empirical evidence and clinical experience, are offered for conducting ethical treatment research with youth and future directions for carrying out research on the ethics of conducting RCTs with youth are offered.