Fixed-time schedule effects in combination with response-dependent schedules

We evaluated the effects of fixed-interval (FI), fixed-time (FT), and conjoint (combined) FI FT reinforcement schedules on the responding of 3 adults who had been diagnosed with schizophrenia. Responding on vocational tasks decreased for 2 of 3 participants under FT alone relative to FI alone. Responding under FI FT resulted in response persistence for 2 of 3 participants. Results have implications for the maintenance of desirable behavior, as well as for situations in which FT treatment has been implemented for problem behavior and problem behavior is nevertheless reinforced by caregivers.     

3～5岁幼儿在主题-规则冲突条件下的类比推理

本研究采用经典类比任务,考察了3～5岁幼儿在主题-规则冲突条件下类比推理发展的水平与特点.结果表明:(1)在无主题联想条件下,幼儿的单维类比推理在3～4岁迅速发展,4～5岁发展较为平缓,而双维类比推理在3～5岁仍处于较低水平.(2)在主题—规则冲突条件下,幼儿在单维类比推理中表现出一定的主题联想优势反应;幼儿在双维类比推理中表现出较强的主题联想优势反应,年龄特点为:3岁幼儿有较强的主题联想优势反应,4岁幼儿的主题联想优势反应明显下降,而5岁幼儿又表现出较强的主题联想优势反应.     

Clinical interpretation: The hermeneutics of medicine

I argue that clinical medicine can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. The literary critic reading a novel, the judge asked to apply a law, must arrive at a coherent reading of their respective texts. Similarly, the physician interprets the text of the ill person: clinical signs and symptoms are read to ferret out their meaning, the underlying disease. However, I suggest that the hermeneutics of medicine is rendered uniquely complex by its wide variety of textual forms. I discuss four in turn: the experiential text of illness as lived out by the patient; the narrative text constituted during history-taking; the physical text of the patient's body as objectively examined; the instrumental text constructed by diagnostic technologies. I further suggest that certain flaws in modern medicine arise from its refusal of a hermeneutic self-understanding. In seeking to escape all interpretive subjectivity, medicine has threatened to expunge its primary subject — the living, experiencing patient.     

急诊医学医患共同决策中的博弈分析

通过急诊医学的实践,借助博弈论方法分析了急诊医学中实施医患共同决策（shared decision making,SDM）的现状,为急诊医学中实施SDM提供参考意见。分析发现,在急诊医疗决策中存在“公地悲剧”“蜈蚣博弈”“博傻理论”等博弈现象。急诊医学中的信息技术滞后、医患对SDM的认知不足、医患信任等因素是影响SDM在急诊医学中实施的重要博弈因素。通过推动急诊医学的信息化建设、SDM理念的普及和技能培训,借助博弈论的方法和相关法律制度的完善,提升互联网作为健康宣传和健康教育的工具作用,有利于SDM在急诊医学的应用推广,从而促进急诊医学和谐医患关系的构建。

     

叙事医学教学对提升医学生共情能力的有效性研究

医学对医学生的人文素养有高度的要求,但医学教学中普遍缺乏对医学生共情能力的教育。为提升医学生共情能力,研究提出多层次叙事医学教学建设,通过特定的训练方法即精细阅读与反思性写作,提高医学生的共情和反思能力,在临床医学专业平行班级中,采用整群抽样方式,试验组进行多层次叙事医学教学,对照组常规教学方式,并通过中文版《杰斐逊共情量表》进行两组共情能力比较。结果表明接受多层次叙事医学教学组共情能力优于常规教学组,更有利于医学生以患者为中心的共情管理能力培养。

     

叙事医学主体间性探析

主体间性源于哲学,是医学的叙事属性之一,与叙事医学关系密切。首先阐述了主体间性的概念和意义,肯定了主体间性在医学中的积极作用,接着分析了叙事医学与主体间性的内在联系,最后分析了叙事医学如何通过关注、再现和归属以及共情和反思实现主体间性。可以说,实践叙事医学是实现主体间性的有效方式,更有利于达成医患双方民主、平等、和谐基础上的相互尊重、理解、沟通和交往,弥合医患分歧,构建和谐的医患关系。

     

Catholic Reflections for an Updated Donum Vitae Instruction: A New Catholic Challenge in a Post-Christian Europe

On February 22, 1987, the Congregation for the Doctrine of theFaith published the Donum Vitae Instruction. Twenty years later,on February 22, 2007, Pope Benedict XVI asked for an updateof this Instruction. According to the Donum Vitae Instructionof 1987, the principle of the holiness of life imposes respectfor human persons from the very beginning of human life. Inthese past 20 years, new medical techniques have raised freshethical issues that are to be addressed by the Roman CatholicChurch Magisterium. The Roman Catholic Church, in its updateof the Instruction planned for 2007, will have to explain howcivil law is to be regulated according to the fundamental normsof the moral law. The moral message of the new Donum Vitae (justas in the 1987 version) will be to affirm the substance of humanjustice: respect for human life, as expressed in the resolvenot to infringe on, or to protect such life. Even in a post-ChristianEurope, this theological message can be understood if it istrue that Europe is marked by the principle of the absoluteprotection of human life.     

现代医学教学理念:比利时基础医学教学分析

比利时是欧洲医学教育的发达国家之一。基础医学教育是整个医学教育中的基石阶段。比利时的基础教育有着浓厚的本国特点。通过从学科融合、教师行为、学生角色及考核方式等多个方面对比利时基础医学教学的优势进行了对比分析,为我国基础医学教育改革提供借鉴和参考。     

近代女子中医学校的诞生及其现代价值

受封建文化的影响,古代女子鲜少能在医学上有所造诣。女医成长主要依赖家族资源,成才具有偶然性。近代以来,随着西学东渐女子教育的兴起,诞生了近代第一批女子中医学校。自李平书开设我国近代第一所女子中西医学校始,到丁甘仁开办的上海女子中医专门学校,再到王慎轩兴办的我国近代第一所妇科函授学校,近代女子中医教育呈现了制度化、规范化、社会化、地域化以及专业化的转型趋势,不仅反映了我国中医教育事业曲折的发展历程,而且反映了近代女性解放的历史进程,具有一定的现代价值。

     

Randomized Controlled Trial of Cognitive–Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting

Standard medical treatments have not been effective for irritable bowel syndrome (IBS) patients. Though individualized cognitive–behavior therapy is an empirically supported treatment option, cognitive–behavioral group therapy (CBGT) has yet to be established as an effective alternative in a randomized controlled trial. This study compared the efficacy of a 10-session CBGT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment for IBS, extending previous quasi-experimental research in this area. Twenty-eight refractory IBS patients, evaluated and referred by gastroenterologists using the Rome criteria, participated in the study. IBS symptoms, psychological functioning, and health-related quality of life were assessed pre- and posttreatment, and at 3-month follow-up. CBGT patients reported significantly more gastrointestinal (GI) symptom improvement than SMTC patients on posttreatment global measures and had significantly reduced daily diary pain scores at 3-month follow-up. Based on MANOVA, there was significant improvement in psychological distress and health-related quality of life for the CBGT patients in comparison to the SMTC patients. These improvements were also maintained at the 3-month follow-up. Reductions in GI symptoms, psychological distress, and improved health related quality of life may contribute to less behavioral avoidance, disability, and health care utilization in refractory IBS patients.