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.     

终末期肾病单病种付费方式患者满意度调查分析

本研究通过调查分析终末期肾病患者对当前单病种付费方式的满意度及影响因素,为医疗保险支付方式改革提供政策依据.研究采用典型抽样方法,对某市四家三级甲等医院257名透析治疗参保患者进行现场自填式问卷调查,调查结果显示,调查人员对终末期肾病单病种付费方式总体满意度为97.3％,对特约医疗机构的满意度高于对医疗保险政策的满意度.患者满意度的主要影响因素有治疗方式、文化程度和家庭收入.医疗保险部门应关注单病种付费政策的结算范围,增加医疗困难救助,加强对医护人员医疗保险政策的宣传,提高患者满意度.     

家庭成员间活体器官及组织捐赠的伦理问题

家庭成员间活体器官及组织捐赠是被绝大多数国家所允许的.虽然利益化减少了很多,但是目前发现其也存在许多的伦理问题.就家庭成员间活体器官及组织捐赠的伦理基础,以及就捐赠风险、种族差异、失衡之爱、操纵、拒绝、退出、潜在利益、特殊疾病等涉及的相关伦理问题进行综述,并就存在的相关问题的解决方法进行探讨.     

27种法学期刊2002年～2011年医事法论文统计分析

以北京大学第五版27种法学核心期刊2002年～2011年刊发的医事法论文为研究对象,分别统计分析其数量、作者、研究内容、基金项目、被引用等信息,据此指出我国近10年医事法研究中存在基础薄弱、缺乏深度、人才不足、资助不力等问题,并提出加快人才培养、搭建研究平台、开展实证研究、加大资助力度、促进医患沟通等建议.     

Shaping Medical Students' Attitudes Toward Ethically Important Aspects of Clinical Research: Results of a Randomized,Controlled Educational Intervention

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics.     

Review of "The Cultural Context of Sexual Pleasure and Problems: Psychotherapy With Diverse Clients," edited by Kathryn S. K. Hall and Cynthia A. Graham

A content and thematic analysis was conducted using forum messages from websites developed for wives of online gamers who play World of Warcraft. Blog posts from 50 women describing conflict in their marital relationship involving their husband's online game play were analyzed. Four overarching themes were identified and discussed in terms of the impact of online gaming on family functioning and relationships, emotional outcomes, and coping mechanisms. Results of ensuing issues arising from excessive gaming as perceived by the non-gaming spouse and ways in which they cope with these issues are shared.     

APP conference summary

This is an account of the extended assessment of a 22-year-old man who was initially sent for a court report, having been accused of setting fires. He had a history both of delinquency and, importantly, of childhood asthma. Although he proved unable to engage in psychotherapy, some management was provided, such as Winnicott advocates in cases of delinquency. This paper explores the symbolic meanings and functions of the patient's delinquent acts, drawing upon theoretical concepts from Freud, Aichhorn, and Deutsch. Of particular importance is the link between this patient's delinquency, his asthma, and the unresolved mourning for his dead mother which he carried not simply for himself but for his whole family.     

Women's views about intimate examinations and sexually inappropriate practices by their general practitioners

Abstract

The aim of this survey of 472 adult women was to assess women patients' feelings about intimate examinations and their perceptions and experiences of sexually inappropriate medical practice. Two-thirds of women preferred a women doctor for intimate examinations. Slightly more than two-thirds found intimate examinations embarrassing and stressful, and strongly expressed the need for information and on-task, health-related comments during these examinations. General personal comments or non-medical touching were not particularly welcomed, even for the purpose of comforting the patient. There was a range of views about patients' personal relationships with doctors, with the lines between acceptable and unacceptable behaviour somewhat ambiguous. A small but significant number of women perceived that they had been sexually harassed (5%) or abused (3%) by a doctor, with this experience more common for non-English speaking women. Results were discussed in terms of implications for improved doctor practice, particularly during intimate examinations and with vulnerable patients.     

A comparison of computer and questionnaire methods of history-taking in a genito-urinary clinic

Abstract

Information on the medical history and symptomatology of 69 patients presenting at a genito-urinary (GU) clinic was obtained either by a computerized interview or a paper questionnaire and the results compared. A comparison was also made between these methods and notes taken during a standard physician interview. Significantly more symptoms were elicited by the computer than the paper questionnaire. Both methods also elicited significantly more symptoms than were recorded by the physician. The patients reported having previously attended a GU clinic more often to the computer than to the physician whereas the questionnaire was no different from the physician. The results indicate that computers can be used satisfactorily to facilitate medical history- taking in GU clinics and may result in a more complete profile of symptoms than either written questionnaire or physician interview.     

Health psychology and uptake of preventive health services: A review of 30 years' research on cervical screening

Abstract

A review of thirty years' research in cervical screening was conducted to assess the role of social and psychological factors in screening utilisation. The role of age, social class, attitudes towards and beliefs about screening as well as social influence and personality variables are considered. A reanalysis of reasons for non-attendance following an invitation for screening from ten previous studies is presented and the importance of theoretical accounts of service utilisation in this area are assessed. Research findings show significant associations for both demographic and psychological factors though poor operationalisations and statistical analyses in previous research make difficult the assessment of their importance as additive, interactive or mediational variables. The significance of service provision issues in terms of both providers' behaviour and the flexibility of delivery is highlighted. The need for further research using a theoretical framework which can unify demographic, psychological and service provision variables is identified.