The diagnostic and statistical manual: sacred text for a secular community?

The Diagnostic and Statistical Manual of Mental Disorders is the most widely used diagnostic system by mental health professionals in North America. It provides a shared language and paradigm by which practitioners view clients. Can it be argued that the DSM represents a sacred text and defines a worldview for an identifiable community of mental health professionals? In what ways is the relationship between this community and document similar to and different from the relationships that explicitly religious communities maintain with their sacred texts?     

全科医学临床诊疗中的决策

临床诊疗的每个步骤,几乎都涉及如何决策的问题.医生应该将患者的利益放在首位,告诉患者拟采取的这些步骤其效果、风险及花费,让患者作出最终的决定.全科医学的精髓是“以人为本”,全科医师更应该帮助患者决策、让患者决策.而全科医疗的特点也决定了必须如此和可能如此.     

Children’s mental health: Time to stop using psychiatric diagnosis

Hegemonic mental health service approaches stress the need for ‘accurate’ diagnosis in order to understand what the correct ‘treatment’ should be. I review the evidence on how far diagnosis in psychiatry has helped advance scientific knowledge and clinical practice and conclude that it hasn’t. I then examine how National Institute for Health and Care Excellence (NICE) guidelines in relation to children’s behaviour problems reflects the lack of progress that results from adopting a diagnostic approach. Taking mental health practice beyond reliance on narrow non-evidence-based diagnostic algorithms can be developed by adopting existing projects such as the Partners for Change Outcome Management Systems project.     

疾病诊断谁说了算：临床诊断？影像诊断？

影像诊断是临床诊断的一个重要组成部分,与问诊、体格检查、实验室检查等一同构成临床诊断。影像诊断不能脱离临床诊断工作而单独存在,影像诊断的结论是否正确需要其他非影像学证据的支撑,其结论不能脱离症状、体征而存在。影像诊断专注于分析图像特征、从图像中寻找诊断证据,不需要采纳其他非影像学证据完善其结论;由于影像诊断是完全来源于图像分析,因而具有不可避免的局限性。影像诊断和其他诊断技术的融合推动了临床诊治技术的进步。     

The sense of the body in the dream: Diagnostic capacity in the meanings of dreams

The author investigates the oneiric representation of somatic states and the diagnostic capacity of dreams. He draws on Freud's hypotheses on the procedures by which somatic stimuli insert themselves in oneiric elaboration and restructures them according to the recent neurobiological discoveries and to analytical experiences. In the representations of certain dreams, with a psychic interpretation agreed upon by the patients, somatic alterations unknown to the analytical couple were discriminated and confirmed by radiological investigations. These representations were linked to the manifestation of one aspect of the bodily Self, neglected in the precocious maternal relation, that entered the organization of the Self consolidated in the relation with the paternal figure. This conjunction gave origin to the double meaning (somatic and psychic) of the dream. The entering of the somatic representation in the oneiric one did not appear to be the figurative effect, but of a condensation of diagnostic capacity into the meaning of the dream. This characteristic manifested itself in the particular styles of the dreamers, interpretable by an analyst countertransferentially oriented. The perception or scotomization of the condensation in the interpretation of the dream and of the moment had an effect on the evolution of the analysis.     

认知诊断框架下多级评分题目的DIF检测方法及其应用

本文对多级计分认知诊断测验的DIF概念进行了界定,并通过模拟实验以及实证研究对四种常见的多级计分DIF检验方法的适用性进行理论以及实践性的探索。研究结果表明：四种方法均能对多级计分认知诊断中的DIF进行有效的检验,且各方法的表现受模型的影响不大;相较于以总分为匹配变量,以KS为匹配变量时更利于DIF的检测;以KS为匹配变量的LDFA方法以及以KS为匹配变量的曼特尔检验方法在检测DIF题目时有着最高的检验力。     

胆道术后胃功能性排空障碍治疗体会

探讨胆道术后胃功能性排空障碍的诊治经验。回顾性分析32例胆道术后胃功能性排空障碍病例。结果32例胃功能性排空障碍发生于术后5天～10天,经保守治疗后均痊愈。胆道术后胃功能性排空障碍是胃的功能性病变,经综合保守治疗是可以治愈的。     

高频超声对膝关节病变的观察

通过超声对髌上囊、股骨髁间软骨情况、胭窝滑囊、髌腱等膝部结构的观察,评价超声对膝关节病变的辅助诊断、观察疗效的价值。通过高频超声对膝关节肿胀、疼痛病例纽与对照组、病例组治疗前后髌上囊液体、滑膜、股骨髁间软骨、胭窝滑囊积液情况以及髌腱厚度及回声进行对比观察。病例组髌上囊液体及滑膜增厚,股骨髁间软骨多有不同程度改变,胭窝滑...