医患会话国内外对比研究

以CNKI期刊全文数据库、Web of Science为数据源,获取国内外医患会话研究论文。采用内容分析和文献计量学等方法对研究论文进行全面分析,以期发现国内外医患会话研究的情况。研究表明,国内医患会话研究经历了起步（2006年~2010年）、发展（2011年~2014年）和繁荣（2015年~2019年）三个阶段,研究主题主要围绕话轮、语用和医患关系三个维度展开。国外医患会话研究在研究论题上更注重实用性和针对性。国内目前的研究在研究对象、方法和过程性研究等方面还存在缺陷,未来研究需要关注语料库建设、跨学科研究、过程性研究和借鉴国外经验等论题。     

生命哲学视角下姑息治疗的追问与反思

姑息治疗是疾病谱变动下医学观念和治疗目的的重要转变,它的出现标志着单纯追求延迟生命长度的医疗时代的结束,生命质量也同样得到重视。然而,姑息治疗的理念在我国出现以来备受争议。首先阐明了姑息治疗的概念和内涵,并从生命的双重性和死亡的尊严角度对其概念和内涵进行审视和阐明。在此基础上,从生命哲学中的生命神圣论和生命质量论的观点进一步剖析姑息治疗医患关系矛盾的产生根源,以期为解决姑息治疗下医患双方的矛盾提供参考。     

患者自主决策的确定性与不确定性

自主原则是医学伦理学基本原则之一,自由意志下的决策被视作实现自主原则的首要条件。通过对自主原则概念的厘定,指出在一些特殊情形下,医生的干涉权大于患者自主性符合伦理要求。进而分别探索在宏观社会学视野和微观社会学视野下,患者自主由于独立而理性的人格和社会道德情感等因素具有的确定性,及患者自主由于个体心理状态、性格和偏见等因素具有的不确定性。以期为医生理性认识患者自主性的有限性,充分实现患者自主,提供理论和实践的借鉴意义。     

察觉、辨析、体验，让医学伦理遍布临床

临床医学伦理有两条进路:外部渗入与内部自生。前者因有伦理规范和相关法律约束,已初步得到落实,后者则是常寓于医疗实践中的常态,难有规范约束,且有背离初衷之事例发生。诸如诊疗方案、新技术的应用、手术、急诊救治、护理等临床实践中的伦理问题,需要通过察觉、辨析、体验的进路才能得以彰显和重视。而坚持医生临床、构建医患间的权力平衡、重视非技术因素在医疗中的作用,启动医师美德的动力机制,则是保证医学伦理遍布临床的重要支撑条件。     

Under what conditions do lay people and health professionals accept a breach of doctor-patient confidentiality regarding a patient with signs of terrorist radicalization?

IntroductionConfidentiality is crucial to the establishment of a strong patient-physician relationship. However, certain situations create a dilemma for the physician who is faced with the choice of either respecting medical confidentiality or protecting others from a serious risk of violence.ObjectiveThis study aimed to observe how lay people and health professionals assessed the acceptability of breaching confidentiality when a physician is confronted to a patient showing signs of terrorist radicalization.MethodA total of 228 participants (174 from the general population and 54 health professionals) judged the acceptability of 54 scenarios which were constructed through the orthogonal combination of 4 factors frequently mentioned in the literature: presence of a “Psychiatric disorder”; “Signs of radicalization”; “Projects of violence”; “Collegiality”. Variance and cluster analyses were performed on all the raw data.ResultsResults showed that all factors influenced the judgment of participants but that “Psychiatric disorders” had a weaker impact. Five clusters were identified: “Favorable if collegiality” (n = 23); “Favorable to breach confidentiality” (n = 77); “Unfavorable to breach confidentiality” (n = 26); “Sensitive to all factors” (n = 71); “Favorable if violence” (n = 31), respectively with mean ratings of 5.87, 8.42, 3.64, 6.30 and 7.16, on an acceptability scale of 0–10.ConclusionThe importance that the great majority of participants attribute to these factors indicates that they influence their judgments in this specific context.     

Yielding behavior and traffic conflicts at cyclist crossing facilities on channelized right-turn lanes

Channelized right-turn lanes (CRTLs) improve traffic flow efficiency, enabling right-turning drivers to bypass traffic lights at signalised intersections (for right-hand drive countries). Many CRTLs provide crossing facilities for pedestrians and cyclists. Previous studies examining the safety performance of CRTLs indicate that they increase overall safety levels but hint that safety issues regarding vulnerable road users exist. This study investigated these issues through site-based observations of yielding behavior and evaluated the effect of the priority rule on cyclists’ safety in two CRTL designs. Four locations in Belgium were selected for video observations: two where the priority rule favoured cyclists and two where motorists had priority.With regard to yielding, four types of crossing behavior were identified and defined. Independent of the priority rule, cyclists crossed the conflict zone first in most interactions without taking the initiative to cross first. Underlying reasons for motorists willingly giving away their right-of-way could not be determined, but possible courtesy or fear of inflicting injuries at vulnerable road users might be at hand. A safety evaluation was performed using two traffic conflict indicators (TTC_min and the TA value). High correlations between the two indicators were found (r² > 0.83), but no conclusions about the safest priority rule for cyclists could be drawn. The results hinted, however, that locations with motorist priority and cyclists crossings from right to left (from the driver’s point of view) yields the highest proportion of safety critical events.     

社会阶层分化视角下医患信息行为对医患关系的影响

目前社会阶层分化进程中的医患关系比较紧张,医患信息行为起了很大作用.由于历史原因多数医师未能认识到医患信息行为对医患沟通及医患关系的影响.患者作为医疗信息掌握的弱势群体,其对从医师处获得信息的依赖将长期存在,医师与患者信息行为必然相互影响.针对信息行为建立相应的培训及评价机制是十分必要的.     

医学生实习与患者就医间矛盾调和

患者就医希望得到经验丰富的医生诊治,而经验丰富的医师往往由无经验的实习医师通过以牺牲患者利益为代价成长起来的.随着医师法的实施和病人要求的提高,实习医师与患者间的利益冲突构成的这一矛盾更加突出.为化解矛盾,通过提高实习医师业务素质和道德素质,增强临床老师责任心等一系列措施,提高病人对医院满意程度,使实习医师圆满完成实习任务.     

The development of social aggression and physical aggression: A narrative analysis of interpersonal conflicts

Using conflict narratives reported by children and adolescents, this study investigated the development and social functions of social aggression in comparison to physical aggression. A total of 510 participants in two cohorts of a longitudinal study were involved (116 girls and 104 boys from Grade 4 and155 girls and 135 boys from Grade 7). Patterns of social aggression and physical aggression were identified based on interview reports in the first year of the study. Results showed that a triadic structure of social relationship was often reported in conflicts where social aggression was employed, whereas a dyadic structure was reported in conflicts involving physical aggression. Girls tended to use social aggression against girls, whereas boys tended to use physical aggression against boys. Children and adolescents who were central in peer social networks were more likely to employ social aggression than those who were peripheral in the networks. Social aggression was not reliably linked to concurrent or future problematic adjustment. Physical aggression, however, was not related to network centrality but was linked to concurrent and future maladjustment (e.g., low academic competence and school dropout). Aggr. Behav. 28:341–355, 2002. © 2002 Wiley‐Liss, Inc.     

The Role of Political Practices in Moral Injury: A Study of Afghanistan Veterans

While much research has been conducted on military trauma, conceptualizations of deployment‐related suffering have been predominantly approached through a medical, individual‐focused lens. Since the military is an instrument of the state, it is crucial to expand the conceptual scope to include political processes, particularly for the fast‐growing literature on “moral injury,” which refers to the emotional impact of perpetrating, witnessing, or falling victim to perceived wrongdoing. This article examines the role of political practices in the onset of moral injury as well as the micropolitical responses of morally injured veterans. A study of the Dutch mission in Uruzgan, Afghanistan, shows that decisions and frames at the political level helped create distressing quandaries on the ground and that in all the ways the political leadership acknowledged the problems that veterans subsequently developed, it also maintained a silence on its direct contribution to these problems, as such perpetuating them. Consequently, veterans tried to make the political leadership take a material and symbolic share in their burden. Clearly, moral conflict may exist both in the veteran and between the veteran and the political domain, and therefore, experiences of institutional betrayal and a resultant search for reparations should be included in theory on moral injury.