急性胰腺炎临床决策中的辩证思维观

急性胰腺炎（AP）是临床常见危重症。近年来AP诊断和治疗取得了令人瞩目的进展,及早诊断和恰当、合理的生命支持治疗极大改善了AP患者的预后。临床上AP患者病情往往复杂多变,要求在极短时间内做出正确的临床决策,科学理性的临床决策思维对AP患者的合理诊治起着非常重要的指导作用。临床医师应努力学习和充分灵活地运用辩证思维,为对AP进行科学的临床诊疗决策提供合理的思路。     

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。     

基层医院年轻医生临床素质现状分析及培养对策

本文对基层医院年轻医生临床素质的现状进行分析,指出了文化层次、福利待遇、带教培养、质控意识、科研热情、人文修养和医疗环境等方面存在的缺陷和不足是导致基层医院年轻医生临床素质低的重要原因。同时呼吁政府加大投入和确保医疗环境安全,加强年轻医生政治思想教育,树立正确的人生观和良好的医德医风,具备良好的心理素质、较好的人文修养和过硬的沟通能力,强化质控意识,引导和培养年轻医生加强临床知识积累,掌握科学的思维方法,从而促进科研水平的提高。     

护理学专业学位硕士研究生临床实践体验研究

采用质性研究中的现象学研究方法,对来自全国各地10所院校的12名护理学专业学位研究生进行半结构式深度访谈。通过对录音访谈内容进行三级编码,逐步归纳提炼出三个主题,每个主题下涵盖不同的副主题：（1）临床实践获益感方面：提升核心能力、体现自身价值;（2）心理体验：归属感、失落感;（3）影响临床实践效果的瓶颈因素：缺乏明确的临床能力考评标准、临床带教师资队伍薄弱。因此,教育者和管理者应重视专业学位硕士研究生,晦床核心能力培养,构建一个充满人文关怀的临床实习环境,消除瓶颈因素,以提高其临床实践效果。     

Human Germline CRISPR-Cas Modification: Toward a Regulatory Framework

CRISPR germline editing therapies (CGETs) hold unprecedented potential to eradicate hereditary disorders. However, the prospect of altering the human germline has sparked a debate over the safety, efficacy, and morality of CGETs, triggering a funding moratorium by the NIH. There is an urgent need for practical paths for the evaluation of these capabilities. We propose a model regulatory framework for CGET research, clinical development, and distribution. Our model takes advantage of existing legal and regulatory institutions but adds elevated scrutiny at each stage of CGET development to accommodate the unique technical and ethical challenges posed by germline editing.     

The Depression Anxiety and Stress Scales: Reference data from a large psychiatric outpatient sample

The published norms for the Depression Anxiety and Stress Scale (DASS) give results for clinical populations that largely fall in the severe to very severe categories. As a result, within this population, the ability to compare the comparative contributions of the underlying emotional components is reduced. The present study presents results from a large general psychiatric outpatient population and provides percentile norms with confidence intervals for both the original DASS and the shorter 21‐item form. It is noted that both forms have high validity but that the correlations between scales are higher than those reported in non‐clinical populations. There was little variation between sexes but some variation of results with age with both younger and older cohorts having lower scores except for the Stress scale where there were higher scores in the older group. There is some evidence of a ceiling effect in the Depression and Stress scales. It was noted that nearly a quarter of patient scores fell within the originally defined normal range suggesting that the DASS would not be a particularly sensitive instrument in its previously reported use as a screening instrument for psychiatric illness.     

THE PAST IS IN THE PRESENT: READING THE WORK OF EDNA O'SHAUGHNESSY

Inquiries in Psychoanalysis: Collected Papers of Edna O'Shaughnessy. By Edna O'Shaughnessy; edited by Richard Rusbridger. London/New York: Routledge, 2014. 342 pp.     

Grounded Theory methods in child psychotherapy research

This article considers the place of qualitative research in psychoanalysis and child psychotherapy. It discusses why research methodology for many years occupied so small a place in these fields, and examines the cultural and social developments since the 1960s which have changed this situation, giving formal but also qualitative methods of research much greater significance. It reflects on the different pressures to develop explicit research methods which arise both from outside the psychoanalytic field, as a condition of its continued professional survival, and from within it, where its main aim is the development of fundamental psychoanalytic knowledge. It suggests that the conduct of mainly quantitative research into treatment outcomes is largely a response to these external pressures, whilst the main benefits to be gained from the development of qualitative research methods, such as Grounded Theory, are in facilitating the knowledge-generating capacities and achievements of child psychotherapists themselves. The paper describes Grounded Theory methods, and explains how they can be valuable in the recognition of hitherto unrecognised meanings and patterns as these are made visible in clinical practice. Finally, it briefly describes three examples of completed doctoral studies, all of which have added significantly to the knowledge-base of child psychotherapy, and which demonstrate how much can be accomplished using this method of research.     

Learning and difficult experiences in graduate training in clinical psychology: A qualitative study of Japanese trainees’ retrospective accounts

This study examined the experiences of Japanese clinical psychology trainees in their graduate school with the aim of identifying factors that might enhance or hinder their learning and professional development. We analyzed the interview data obtained from 17 clinical psychologists using grounded theory approach. Two major category groups were generated: Developing as a Clinician and Difficulties. The primary positive learning experiences in Developing as a Clinician were labeled “Hot Learning,” in which trainees acquired professional knowledge and skills through close interpersonal engagement with clients, peers, faculty, and supervisors. In contrast, Difficulties involved trainees’ negative experiences resulting in feelings of self-doubt and incompetence. These experiences occurred in close but sometimes conflicted interpersonal contexts, where trainees felt evaluated in a manner incommensurate with the support they received. We found that the quality of interpersonal relationships, which provided the context for optimal learning for trainees, was paramount to the definition of positive versus difficult learning experiences. Implications for therapist training, professional development and future research are discussed.     

The Parable of the Sower: a case study examining the use of the Godly Play® method as a spiritual intervention on a psychiatric unit of a major children’s hospital

This case study examines the use of Godly Play® as a pastoral intervention on a psychiatric unit at Children’s Health – Children’s Medical Center in Dallas, Texas. The chaplain adapts Godly Play®, more typically used as a programme of Christian formation in churches and schools, for this setting, leading a ‘Purpose and Meaning’ group weekly whose goal is to provide inpatients with a developmentally appropriate way of reflecting on and expressing their own sense of identity, purpose and meaning within the personal, social and spiritual milieu in which they identify themselves as members. The case study examines how the method is adapted as a spiritual intervention in a clinical setting, and analyses its effectiveness in meeting the stated goals of the group.