神经外科高新技术应用中的人文问题

文在分析医疗高新技术给神经外科带来发展的同时,阐述了其所带来的一系列人文问题.并对神经外科医务人员如何在临床中合理应用医疗高新技术,把握好医患关系,合理利用医疗资源,表现良好的医德医风提出了要求.     

Making the most of information‐gathering interviews with children

Because child abuse victims are often the only available sources of information about their experiences, extensive efforts have been made to understand how to maximize their informativeness. There is now broad international consensus regarding optimal interview practices, and broad awareness that children's informativeness increases when interviewers conduct developmentally appropriate interviews with children. In this paper, we (1) summarize current understanding of how children remember, retrieve, and communicate information and (2) discuss ways in which children's memory and reporting can be fostered using techniques designed to help children recount past experiences such as the Cognitive Interview, the Narrative Elaboration Technique, and the National Institute of Child Health and Human Development‐Protocol. Communicative success clearly depends on how well children understand their role and how effectively interviewers take advantage of children's competencies and abilities to help them maximize their informativeness. Unfortunately, agreement regarding ways in which interviews should be conducted has not been paralleled by changes in the way interviews are actually conducted in the field and more attention thus needs to be paid to training and implementation. Copyright © 2008 John Wiley & Sons, Ltd.     

Analysis of the creation of 'emptiness', of 'nothingness', in certain types of psychosis

Some psychotic patients manage to create nothingness and emptiness thanks to the amount of work their ego accomplishes. That is the paradox we find in schizophrenic patients, their ego is simultaneously weak and powerful. When we analyse how this nothingness/emptiness is created, we enter into a strange world in which the patient's ego is, in part, defective and fragmented; his or her thinking apparatus, capacity for perceiving and feeling are under attack. Yet this same ego can call on intellectual ability, imagination and tremendous energy in order to create a highly complex structure, thanks to which the psychotic individual manages to create a kind of para-organization of space by splitting 'nothingness' (the space between representations) and 'density' (a compact magma made up of many different highly-condensed representations). Both nothingness and density may give the impression that the patient is 'nowhere to be found' and therefore impossible to analyse. In this paper, I shall describe these mechanisms as they appear in the clinical material of a female psychotic patient.     

The Frequency of Prayer,Meditation and Holistic Interventions in Addictions Treatment: A National Survey

This study examines the prevalence of endorsing the twelve step approach and the use of prayer, meditation, and holistic techniques in a national sample of 139 substance abuse treatment centers. Ninety one percent of the programs endorsed a twelve step orientation. Twenty six percent of the programs actively used prayer and 58% used meditation as a component of treatment. Thirty three percent of the programs used some form of a self-designated holistic technique. There was a divergent range of techniques that were used by programs, falling into four broad categories: (1) nutrition, exercise, relaxation and physical health; (2) recreation and adventure-based activities; (3) religious and spiritual practices; and (4) the use of specific therapy modalities.     

重参数化多分属性DINA模型的多级评分拓广——基于等级反应模型

多分属性认知诊断模型（CDMs）比传统的二分属性CDMs提供更详细的诊断反馈信息,但现有大部分多分属性CDMs并不具备直接分析多级（或混合）评分数据的功能。本文基于等级反应模型对重参数化多分属性DINA模型进行多级评分拓广,开发一个可处理多级评分数据的等级反应多分属性DINA模型。首先通过实证数据分析呈现新模型的现实可应用性;然后通过模拟研究探究新模型的参数估计返真性。结果表明,新模型满足同时处理多分属性和多级评分数据的现实需求;且具备良好的心理计量学性能,但对测验质量有一定要求（如题目质量较高且测验Qp矩阵具有完备性等）。     

The Commercialization of Clinical Genetics: An Analysis of Interrelations Between Academic Centers and For-Profit Clinical Genetics Diagnostics Companies

The field of clinical genetics has undergone substantial commercialization, including the development of genetics diagnostics companies. Numerous for-profit corporations now offer genetic diagnostic services; until recently, these clinical services were provided almost exclusively through academic, not-for-profit medical centers. Some of these for-profit corporations have business and/or research relationships with academia. An evaluation of the interconnections between academia and the clinical genetics industry is an important first step in analyzing the risks and benefits of commercialization. We analyzed the personnel and business affiliations of 19 major U.S. for-profit clinical genetics diagnostics companies with universities, academic medical centers, and the scientific and medical genetics communities in a 2-year period, 1991–1992. We noted extensive connections between the for-profit sector and academia. At least 17% of high-ranking personnel and 85% of consultants for the companies had one or more academic ties. At least 68% of the companies had one or more business agreements with at least one university or academic medical center. These results raise many issues regarding the delivery of genetic medicine and the structure and function of academic medical genetics centers.     

Who's Up First? Testing for Order Effects in Structured Interviews Using a Counterbalanced Experimental Design

A growing body of research suggests that, apart from the wording of specific questions, various aspects of the interview process itself may affect the reliability of information provided by research participants. To examine whether the order of presentation of specific diagnostic modules affects the likelihood of subjects' yes/no responses within the Diagnostic Interview Schedule for Children (DISC), the authors used a counterbalanced design, presenting two DISC diagnostic modules to children and their parents in standard or reversed order. Results indicate that the order of module administration exerts effects on the total numbers of symptoms endorsed, level of impairment, and the likelihood of meeting diagnostic criteria, regardless of whether the information is provided by parent or child respondents. Future child and adult assessment measures should take these difficulties fully into account through novel approaches to instrument design and interview procedures.     

Subject and Interview Characteristics Affecting Reliability of the Diagnostic Interview Schedule for Children

Despite the well-known difficulties in obtaining reliable and valid assessments of child psychopathology, investigators generally have not examined the influence of factors such as subject characteristics or the specific assessment procedures themselves on the validity of the information obtained. To address these issues, this special section presents four studies of the Diagnostic Interview Schedule for Children, in which investigators examined the impact of a range of variables on the reliability of its symptom and diagnostic information. Factors studied include interview structural characteristics; question length, complexity, and placement within the interview; and interview subject characteristics. Overall findings suggest that interview and subject characteristics exert important influences on the data obtained, and that novel approaches, such as allowing subjects a greater role in the ordering of questions to be answered, may improve the precision and accuracy of such measures of children's psychopathology.     

新技术革命前沿的神经外科

近年来,由于新技术革命的发展和信息交流的加快神经外取得了突飞猛进的发展,主要表现在ＣＴ、ＭＲＩ、ＤＳＡ、ＰＥＴ、ＩＯＭ、术中导航系统和远程医疗的应用等方面,使神经外科的诊断和治疗水平有了长足的发展。     

Maximizing the coefficient of generalizability under the constraint of limited resources

A procedure for maximizing the coefficient of generalizability under the constraint of limited resources is presented. The procedure uses optimization techniques that offer an investigator or test constructor the possibility of employing practical constraints. The procedure is illustrated for the two-facet random-model crossed design.