构建高质量的外科医学教育体系

医学教育是贯穿医疗职业生涯全过程的行为,是伴随医学进步和发展的重要工程.医学教育的质量直接影响医疗的质量和医学人才的素质,尤其是外科学领域,是以有创性的手段、方法治疗疾病.医生的职业素养、医疗水平均取决于医学教育的结果.医疗质量不能简单地用医生的学历衡量,学历教育是载体,其中应充实培养能力的教育项目、内容,以适应未来就职、就业的社会需求.医疗质量、医疗水平对医院而言是生命线,是生产力.同时,医生的教育及教育的质量是医疗质量的基础与保障.随着医学的飞速发展,医疗技术的日新月异,医学模式的改变,构建新的医疗环境下的医学教育体系,显得更为重要.     

Center-Based Care for Young Children: Examining Predictors of Quality

The authors collected information from caregivers, trained observers, and parents to investigate quality elements in child-care programs designed for young children in center-based settings. Participants were 75 parents of children aged 15 to 36 months and their caregivers from 13 child-care centers in a southeastern state. Observers collected indicators of program quality and process and structural quality indicators, including adult-child ratio, group size, use of planned activities, use of child-designated space, housekeeping activities, and caregiver-child interactions. Participants responded to questions regarding their child-rearing beliefs, social support networks, perceived stress levels, and demographic characteristics. The best predictors of higher quality care and sensitive caregiver-child interaction in centers were specialized caregiver training, higher adult-child ratios, use of planned activities, and less perceived stress by caregivers. Implications of these findings are discussed.     

Some thoughts and responses to The Francis Report

This response to the report by lawyer Robert Francis into the failure of National Health Service (NHS) care in Mid-Staffordshire is fairly positive about its conclusions but points out that without consideration of personal, psychosocial factors in care, on the ward, in the institution things are unlikely to improve, the report leaves much unconsidered. Francis emphasises that patient care is at the very centre of the NHS, this is obvious but so often forgotten. He comments that the unhelpful blame culture still exists. Missing from Francis’ analysis is a psychological perspective – the systemic factors he mentions are administrative not relational. This response is an attempt to redress the balance in thinking about the improvement of care for patients and of the working lives of staff.     

Organizational schism: Looking after a psychiatric service

What is opposed to psychoanalysis is not psychiatry but psychiatrists. (Freud, 1916–1917, p. 254)     

A Program Intervention for Pediatric Bipolar Disorder: Preliminary Results

The effectiveness of a behaviorally based day treatment program for young children diagnosed with Pediatric Bipolar Disorder (PBD) was evaluated using pretreatment and posttreatment mean scores from the Child Behavior Checklist (CBCL). Data were evaluated in aggregate and using the clinically significant change method for children diagnosed with PBD, Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Adjustment Disorder, and no diagnosis/clinical and subclinical groups. Significant effects were found for all groups except the no diagnosis/subclinical group on the Internalizing scale and for all groups on the Externalizing scale. Clinically significant change was supported for the PBD, ADHD, ODD, and Adjustment Disorder groups. Implications and limitations of the study are discussed.     

Effects of Hardiness and Years of Military Service on Posttraumatic Stress Symptoms in U.S. Army Medics

We examined the effects of hardiness on symptoms of posttraumatic stress (PTS) in postdeployed U.S. Army medics (N = 322). Medics endure a high level of work-related stress on and off the battlefield. Hardiness correlated negatively with reports of PTS symptoms and moderated the cumulative effects of years of military service on PTS symptoms. After controlling for socially desirable responding, PTS symptoms increased with years of military service for those with low levels of hardiness and decreased with years of military service for those with very high levels of hardiness. The military’s current resiliency training programs would likely benefit from incorporating hardiness measures and principles into its curriculum.     

Short‐term cognitive‐behavioral treatment in multicultural primary care of patients with longstanding backache

The efficacy of cognitive‐behavioral therapy in multi‐cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly‐treatment given by primary care physicians regarding pain‐related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45 years, entering rehabilitation program because of longstanding backache. Prevalences of pain‐related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain‐related worry and/or persistent depression and severe pain (VAS ≥ 50). The prevalences of pain‐related worry and depression were both significantly lower after treatment (pain‐related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring ≥ 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain‐related worry (OR 2.1; 95% CI 1.1–4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6‐5.4). The rating of VAS rating ≥ 50 after treatment was twice as high, OR 2.3 (95% CI 1.1–4.6) in the 38–45 year old age group. To conclude, a focus on pain ideas reduced pain‐related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.     

Creating a ‘psychological nest’ for vulnerable infants and children: an interview with Annette Mendelsohn

This is an edited version of a recent interview with Annette Mendelsohn, Child and Adolescent Psychotherapist at the Royal Free Hospital, London, UK. It aims to make available in published form Mendelsohn's thinking and approach in relation to her work with traumatised children in a hospital setting. Mendelsohn also discusses her work in a neonatal intensive care setting and the way in which approaches to psychosocial care in the hospital setting have changed over the course of her professional life.     

Premature twins on a neonatal intensive care unit

This paper presents observations of boy and girl twins on a neonatal intensive care unit, following them through from 10 days old to return home. The observer hypothesizes about the experience of the twins as they progress, based on detailed notes of their actions. The preoccupations of the parents are incorporated, as are reactions and interventions of staff. The place and possible functions of such observation by a child psychotherapist attached to such a unit are elaborated in the concluding section.