目前形势下临床教学问题的探讨与改革

当前医疗大环境的改变,社会评价的影响及病人的维权、自我保护意识等使临床教学工作发生了很大变化.需要我们采取相应的变革,注重病历的书写,基本功的培训,语言能力的指导和改变查房的方式,以完成培养新一代合格医生的任务.     

建立有中国特色的卒中单元

卒中单元是一种医疗管理模式,它将治疗脑卒中的有效手段集中在一起,让病人在有效治疗时间窗内的到他所需要的最佳治疗,尽可能地使卒中病人恢复神经功能,恢复自我,回归社会。但我国的卒中单元还存在许多问题,需共同努力建立有中国特色的卒中单元。     

医患双方对医患关系认知差异性的调查分析

采取整群随机抽样方法,现场调查发现,医患双方对医患关系重要性的认知一致,而对其性质、发展趋势、法律适用,以及医患冲突的主要诱因、责任主体、主要解决方式的认知状况均存在着显著性差异。相互理解、交流和尊重是建立和谐医患关系的根本措施。     

Exploring counsellor perceptions of the impact of counselling supervision on clients

This qualitative study explores counsellors’ experiences and perceptions of how counselling supervision impacts upon their clients. Data collection combined open‐ended questionnaires (n = 13) and semi‐structured interviews (n = 6). The findings indicate that supervision impacts client work both helpfully and unhelpfully. Areas that emerged as having the most direct impact on client work were the counselling relationship dynamics and self‐awareness, professional development, emotional support, clients not discussed in supervision and the quality of the supervisory relationship. Congruence and confidence were the most direct link between supervision and client work.     

The basic traumatic situation in the analytical relationship1

The author attempts to develop a concept of psychic trauma which would comply with the nucleus of this Freudian notion, that is, an excess of excitations that cannot be processed by the mental apparatus, but which would also consider the functions and the crucial role of objects in the constitution of the psychism and in traumatic conditions, as well as taking into account the methodological positioning according to which the analytical relationship is the sole possible locus of observation, inference and intervention by the psychoanalyst. He considers as a basic or minimal traumatic psychoanalytical situation that in which a magnitude or quality of emotions exceeds the capacity for containment of the psychoanalytical pair, to the point of generating a period or area of dementalisation in the psyche of one or both of the participants, of requiring analytical work on the matter and promoting a signifi cant positive or negative change in the relationship. Availing himself of Bion's theory about the alpha function and the metapsychological conceptions of Freud and Green concerning psychic representations, he presents two theoretical formulations relating to this traumatic situation, utilising them according to the ‘altered focus’ model proposed by Bion. He presents three clinical examples to illustrate the concept and the relevant theoretical formulations.     

Los Degradados: Out,down, dead: Transmitted and inflicted trauma as encountered in the analysis of a 6‐year‐old girl1

The author presents the analysis of a precocious traumatized little girl, which reveals the ways in which historical trauma is transmitted and intrafamilial trauma is both disguised and represented. The play as it evolves is seen to simultaneously communicate what the child struggles with and to resolutely try to hide what has actually happened. Analyst and child together participate in play which utilizes displacement, enactment and interactive enactment, the latter play mode being the very hallmark of profound traumatic experience. Carlotta, the child, helps the analyst to follow her quest for meaning making even as the interaction between them adheres to and departs from the deepening pentimenti of traumatic experience, which needs to be unraveled and reconstructed in order that her own developmental progression can be rejoined. The analysis facilitates Carlotta's capacity to play in a more unfettered fashion and to assist her family's recovery as well.     

Contextual Influences on Marriage

Abstract— Current proposals to promote and strengthen marriage among low-income populations focus on values and behavioral skills as primary targets of intervention. Marital research that examines contextual influences on marriage calls these emphases into question. Ethnographic and survey research reveal no evidence that populations experiencing higher rates of divorce value healthy marriages any less than other populations do. Longitudinal and observational research reveals two mechanisms through which the environment of a marriage may enhance or constrain effective relationship maintenance. First, some environments contain fewer sources of support and pose more severe challenges than others, presenting marriages in those environments with greater burdens than marriages in more supportive environments are faced with. Second, when demands external to the marriage are relatively high, even couples with adequate coping skills may have difficulty exercising those skills effectively. Together, such findings suggest that successful policies and interventions to strengthen marriages need to acknowledge the environments within which marriages take place.     

论当前我国医疗市场对医患关系的影响

解读目前紧张的医患关系是一个迫切的社会课题.医疗服务是一种商品,医疗市场是客观存在的,它是导致医患关系紧张的深层次原因.     

青少年理想自我表征的丰富性及其调节作用研究

本文尝试对青少年理想自我表征丰富性进行量化研究,并着重从压力缓冲和人际交往角度探讨了理想自我表征丰富性对个体心理健康的调节作用,以及理想自我表征丰富性与弹性的关系.研究结果表明,青少年理想自我表征丰富性不存在年龄差异,而在性别上存在差异,且这种差异主要存在于初中男女生之间;丰富的理想自我表征有利于缓冲青少年对压力的负性体验,并在一定程度上影响他们在同学中的人缘.此外,理想自我表征丰富性对心理健康的调节主要通过弹性中介发挥作用,预示着理想自我表征丰富性可能是青少年弹性的重要构成成分.     

关于临床实践教学中患者隐私权的调查与分析

临床实践教学中患者隐私权的界定与保护一直是舆论界和学术界争论的问题之一.通过发放调查问卷,综合分析患者、医学生及带教医生对这一问题的观点,为解决这一争议进行了理性的思考,并给出了合理的建议.