从医师的视角浅析医疗差错的辩证观

医疗差错是影响医疗安全的最重要因素。有效预防和正确处理医疗差错,需要以科学辩证的认识为前提。当前,我国医院管理实践在一定程度上缺乏对医疗差错的辩证认识,导致在处理上存在些许不足。本文从医师的视角,对如何辩证地认识医疗差错进行浅述。指出,医疗差错在相当程度上源于人的出错之天性和医学的复杂性,广泛存在于医疗实践中,发生具有必然性;虽然从表象上看,医疗差错的原因是局部的,但其本质的原因是系统性的;医疗差错是医疗安全系统运行状况的"指示灯",有助于及时地了解安全系统的薄弱环节,为完善和提升系统安全、提高医疗服务水平提供契机。     

消化系统疾病与精神心理因素的辩证关系

消化系统疾病与精神心理因素相互影响,其相互作用呈现个体化差异,这与个体间的内环境以及外环境差别有关。主要病理生理学机制之一为"脑-肠轴"及"脑肠互动"学说。临床医生需要认识到二者之间辩证关系的普遍性和重要性,及时发现躯体症状背后潜藏的精神心理问题,综合运用各种心理干预和药物治疗手段。     

口腔种植诊疗实践中的思考

口腔种植现已经出现在人们的视线里,它具有一定的特殊性和优越性,能够解决常规修复手段不能解决的问题,然而在临床应用中,需要考虑和处理的问题往往很复杂。因此有必要在临床实践中运用辩证思维及循证医学的思想,在诊断中全面考虑、周密计划;在治疗中处理问题、解决难点;在随访中发现问题,促进发展。     

浅谈自发性脑出血诊断的辩证思维

自发性脑出血作为临床常见疾病,其背景复杂,对其予以准确诊断较为困难。除最常见于高血压性脑出血外,其既可作为某些疾病的首发表现,也可作为其他疾病的并发症或某些药物治疗的副作用而出现。其准确诊断除需具备完整临床知识结构外,亦要求我们具有辩证思维。本文旨在从辩证思维和临床角度探讨自发性脑出血的准确诊断。     

Using Liberation Psychology and Dialectical Humanism to Understand Latinx Adolescents’ Life Satisfaction and Depressive Symptoms

The authors conducted a study to examine how the presence of meaning in life, search for meaning in life, hope, family importance, and enculturation influenced Latinx adolescent students’ depressive symptoms and life satisfaction. Two regression models revealed there was a statistically significant relationship between predictor variables, life satisfaction, and depression. The article concludes with a discussion regarding the importance of these findings and recommendations for practice and research. Los autores llevaron a cabo un estudio para examinar cómo la presencia de sentido en la vida, la búsqueda de sentido en la vida, la esperanza, la importancia de la familia y la enculturación influyeron en los síntomas depresivos y satisfacción vital de estudiantes adolescentes Latinx. Dos modelos de regresión revelaron que existe una relación estadísticamente significativa entre las variables de predicción, la satisfacción vital y la depresión. Este artículo concluye con una discusión en torno a la importancia de estos hallazgos, así como recomendaciones para la práctica y la investigación.     

A systematic review and meta-analysis of dropout rates from dialectical behaviour therapy in randomized controlled trials

ABSTRACT

Dropout is an important factor that may compromise the validity of findings from randomized controlled trials (RCTs) of dialectical behaviour therapy (DBT). We conducted a targeted meta-analytic review of dropout from RCTs of DBT, with the aims of (1) calculating average rates of dropout from DBT; (2) investigating factors that moderate dropout; (3) examining whether dropout rates from DBT differ to control interventions; (4) synthesising reasons for dropout. Forty RCTs of DBT met full inclusion criteria. The weighted mean dropout rate was 28.0% (95% CI = 23.6, 32.9). Dropout rates were not related to target disorder, dropout definition, delivery format, therapist experience, and therapist adherence. Unexpectedly, dropout rates were significantly higher in trials that offered telephone coaching and utilized a therapist consultation team. DBT dropout rates did not significantly differ to dropout rates from control interventions. Few trials reported reasons for dropout, and there was little consistency in the reported reasons. Findings suggest that over one in four patients drop out from DBT in RCTs. This review highlights the urgency for future trials to explicitly report detail pertaining to patient dropout, as this may assist in the development of strategies designed to prevent future dropouts in RCTs of DBT.