综合医院恶性肿瘤诊治现状与伦理思考

恶性肿瘤的诊断与治疗是当今医学领域的一个研究热点。阐述了综合医院恶性肿瘤的诊治现状,并提出在恶性肿瘤诊治的临床实践中应遵循的伦理原则,目的是呼吁有关部门及广大医务工作者应加强对恶性肿瘤诊治的质量控制和对恶性肿瘤患者实施规范化综合性治疗。     

大学时期早期的通识伦理教育

通识教育的目的在于建立人的主体性,以完成人之自我解放,并与所互为之人文及自然环境建立生存主体性的关系。通识教育可区分为核心课程与一般课程两个层次。伦理是教养之大成,医学伦理是医者把认知、发展与修养在医患关系上的努力。动之以情,说之以理,诉立以法,是通识伦理教育的一般方法。     

TEACHING SELF-CATHETERIZATION SKILLS TO CHILDREN WITH NEUROGENIC BLADDER COMPLICATIONS

We examined the effects of simulation training on the acquisition of self-catheterization skills in 2 female children with spina bifida. Based on a task analysis, the children were taught to perform on a doll each of the components of preparation, and, using a mirror to locate the urinary meatus, to insert and remove the catheter and to clean-up. Before, during, and after training, the children's performance of the skills on the doll and on themselves was assessed. Results of a multiple baseline design across subjects and skill components showed that doll training facilitated the children's acquisition of self-catheterization skills.     

A PROBLEM-SOLVING APPROACH TO SOCIAL SKILLS TRAINING IN EMPLOYMENT SETTINGS WITH MENTALLY RETARDED YOUTH

The present study examined two approaches to teaching social behaviors to 3 developmentally disabled youths in work contexts. In one approach, a problem-solving procedure was learned and transferred to different materials. Conversational probes monitored interactions between disabled employees and their co-workers and customers. A multiple baseline design demonstrated that the training produced generalization and maintenance of the targeted social behaviors to the work settings. A second approach based on a role-playing intervention produced no substantial generalization in the work setting. A social validation questionnaire administered to co-workers supported the efficacy of the problem-solving training procedure. The efficacy of social problem-solving training was discussed in terms of sufficient exemplars, common stimuli, and self-mediations.     

Social competency and social perceptivity in self and others

Males who self-reported heterosocial problems and whose role-play interactions were judged to be low on social competence were compared to a group of high socially competent males on their ability to judge their own and others' social competency. Results indicated that in comparison to the high-competent group, low-competent males showed less agreement with judges in rating their own and others' levels of competency. Using profile components of elevation, scatter, and pattern, more detailed analyses showed that the two groups differed primarily on scatter. The low-competent individuals had less scatter, suggesting that they have a discrimination deficiency. Implications of the results are discussed for the etiology and treatment of social incompetence and for future research.     

TEACHING FUNCTIONAL COMMUNITY SKILLS TO AUTISTIC CHILDREN USING NONHANDICAPPED PEER TUTORS

In this study, two autistic children were paired with normal peers who, after pretraining sessions, taught community skills to the autistic children. Data were collected during three conditions: baseline, modeling, and peer tutoring. Results demonstrated that no identified skills were acquired during the baseline and modeling conditions. However, direct instruction of each child by a peer tutor resulted in the learning and maintenance of functional community skills.     

TRAINING APARTMENT UPKEEP SKILLS TO REHABILITATION CLIENTS: A COMPARISON OF TASK ANALYTIC STRATEGIES

The research was designed to validate procedures to teach apartment upkeep skills to severely handicapped clients with various categorical disabilities. Methodological features of this research included performance comparisons between general and specific task analyses, effect of an impasse correction baseline procedure, social validation of training goals, natural environment assessments and contingencies, as well as long-term follow-up. Subjects were taught to perform upkeep responses on their air conditioner-heating unit, electric range, refrigerator, and electrical appliances within the context of a multiple-probe across subjects experimental design. The results showed acquisition, long-term maintenance, and generalization of the upkeep skills to a nontraining apartment. General task analyses were recommended for assessment and specific task analyses for training. The impasse correction procedure generally did not produce acquisition.     

A PERSONALIZED SYSTEM OF INSTRUCTION FOR TEACHING CHECKING ACCOUNT SKILLS TO ADULTS WITH MILD DISABILITIES

This study evaluated the efficacy of a personalized system of instruction to teach checking account skills to persons with mild disabilities. Using a self-paced manual, 8 participants in two groups were taught to write checks, complete deposit slips, and reconcile monthly bank statements. Four participants were assessed for generalization from the classroom to community sites and demonstrated nearly perfect performance. A multiple probe design showed that acquisition occurred sequentially for each skill only after training using the self-paced manual. Follow-up sessions demonstrated that participants maintained the checking account skills. The results provide evidence of the effectiveness and adaptability of a personalized system of instruction for teaching complex monetary skills to persons with mild disabilities.     

ENHANCING CONVERSATION SKILLS IN PATIENTS WITH ALZHEIMER'S DISEASE USING A PROSTHETIC MEMORY AID

The effectiveness of teaching Alzheimer's disease subjects to use a prosthetic memory aid when conversing with familiar partners was evaluated. Effects of the training of three topics by caregivers was assessed in daily probes with the experimenter and twice weekly probes with a familiar conversational partner. All 3 subjects learned to use the memory aid with both conversational partners and improved the quality of their conversational content. Subjects made significantly more statements of fact and fewer ambiguous utterances after training on each topic according to a multiple baseline design. All subjects also generated novel, untrained statements in conversations with both partners. Treatment effects were maintained at high levels throughout training and at 3- and 6-week followup sessions. Naive judges rated baseline and posttreatment conversational samples as significantly improved on all eight conversational dimensions.     

TEACHING YOUTHS WITH AUTISM TO OFFER ASSISTANCE

Three adolescent boys with autism were taught to offer assistance to a person stating inability to complete a task. The study used a multiple baseline across the 3 youths and a multiple baseline across three tasks for each student. Both designs provided clear support for the ability of the youths to discriminate those settings in which offers of assistance were desired. All 3 participants showed relatively rapid acquisition of responding. Generalization was assessed to a new person in the training setting, to a familiar person in a new room at the center, to the mother in the youth's home, and to three novel tasks. Generalization to a new person in the familiar setting was most likely to occur, with very high levels of responding for all 3 youths. Generalization to the other conditions varied across youths, although all 3 boys showed some transfer of skills to all conditions.