浅析当前临床科学决策的几个影响因素

随着循证医学在我国的发展和"医疗举证责任倒置"等相关法律的实施,我国临床医生在进行诊治决策时已逐步向临床科学决策迈进。而防御性医疗、不健全的医疗制度及相关法律等却严重影响着这一科学决策的转变过程。只有有效解决了导致干扰科学决策的各种社会影响因素,如扩大基本医疗保险的覆盖率,实施医疗风险保险制度,提高医务人员认知和职业素质,保障行医安全等,临床科学决策的真正落实就大有希望。     

从中药的安全性谈中药产业的危机管理

药物的安全性是药物评价的首要标准。《欧盟传统药品法案》对中药的技术壁垒和我国对某些中药的毒副作用的披露,使得中药的安全性问题日益突出,使得中药产业面临前所未有的危机。对中药安全性的理性认识是扩大其国内市场占有率、走向国际市场所必须突破的瓶颈,也是中药产业危机管理的必由通道。这是一场深刻的文化革命。     

Informed Consent Procedure for Clinical Trials in Emergency Settings: The Polish Perspective

Setting reasonable and fair limits of emergency research acceptability in ethical norms and legal regulations must still adhere to the premise of well-being of the research subject over the interests of science and society. Informed consent of emergency patients to be enrolled in clinical trials is a particularly difficult issue due to impaired competencies of patients’ to give consent, short diagnostic and therapeutic windows, as well as the requirement to provide detailed information to participants. Whereas the Declaration of Helsinki, Good Clinical Practice guideline, Additional Protocol to the European Bioethical Convention concerning Biomedical Research, as well as appropriate regulations adopted by the Food and Drugs Administration (USA) allow waivers from participants’ consent or deferred consent for emergency research, the regulations of most European Community countries following the Clinical Trial Directive (2001/20/EC) do not give space for a deferred consent or a waiver from consent for adult patients (unless surrogate consent is made use of). This is even more confusing in case of Poland, where conflicting regulations on a waiver from a participant’s consent in emergency research exist and the regulations on surrogate consent of temporarily incompetent adults are too restrictive and authorise only the guardianship courts to consent, which is not or hardly feasible in practice. European Community regulations need to be amended to allow for implementation of the deferred consent or waivers from consent for emergency research in order to enable ethical research of emergency conditions that should become a large part of important public health priorities.     

专科医生应注重整体性和系统思维训练——由一例甲亢患者门诊长期误诊引发的哲学思考

临床医学专科的发展对促进医学科学的进步起到了重要的推动作用,尽管它可能缺乏整体性、系统性临床思维,但在可预见的将来,它仍是综合性医院医疗实践的主旋律,医学界应对此有较为清醒的认识。本文从哲学的角度分析了造成误诊的原因,然后指出防止或减少误诊的途径是培养科学的临床思维,并提出了在临床过程中培养整体思维和系统性科学思维的一些方法。     

疾病的哲学思考——坦然和平静地对待疾病

面对人类无法改变与疾病共存的命运,本文从健康与疾病的关系、疾病的原因、疾病的话语、对待疾病的态度和利用疾病的契机五个方面来进行哲学追问和反思。以期使我们通过倾听身体的语言,来坦然、自然和平静地对待疾病;利用疾病的契机,获得身心的成长,使人类的生命在亘古的绵延中永远充盈着盎然的生机。     

新形势下医院药学的困境与发展

全面分析在当前新的形势下医院药学发展处在转型期所面临的实际困难。正确认识目前医院药剂科在人才队伍建设和知识结构上存在的不足,以及自身拥有的专业技术优势等。明确今后工作的重点在于深入临床贴近患者,向临床药学服务方向发展,同时不断提高临床药学科研水平,促进医院药学事业更高、更快发展。     

Cognitive epidemiology: With emphasis on untangling cognitive ability and socioeconomic status

This commentary touches on practical, public policy, and social science domains informed by cognitive epidemiology while pulling together common themes running through this important special issue. As is made clear in the contributions assembled here, and others (Deary, Whalley, & Starr, 2009; Gottfredson, 2004; Lubinski & Humphreys, 1992, 1997), social scientists and practitioners cannot afford to neglect cognitive ability when modeling epidemiological and health care phenomena. However, given the dominant concern about the confounding of general cognitive ability (GCA) and socioeconomic status (SES), and the extent to which SES is frequently seen as the primary cause of health disparities (while GCA is neglected as a possible influence in epidemiology and health psychology), some methodological applications for untangling the relative influences of GCA and SES are reviewed. In addition, cognitive epidemiology is placed in a broader context: Just as cognitive epidemiology facilitates an understanding of pathology (“at risk” populations, and ways to attenuate undesirable personal and social conditions), it may also enrich our understanding of optimal functioning (“at promise” populations, and ways to identify and nurture the human and social capital needed to develop innovations for saving lives, economies, and perhaps even our planet). Finally, while GCA is likely the most important dimension in the study of individual differences for modeling healthy behaviors and outcomes, other relatively independent dimensions of psychological diversity do add value (Krueger, Caspi, & Moffitt, 2000). For example, compliance has at least two psychological components: a “can do” competency component (ability) and a “will do” motivational component (conscientiousness). Ultimately, developing and modeling healthy behaviors, interpersonal environments, and medical maladies are best accomplished by teaming multiple dimensions of human individuality.     

循证医学及其在心血管疾病中的应用

循证医学作为一门新兴的学科,对医学的研究和实践将产生越来越大的影响。在循证医学的操作过程中,如何正确评价和应用所获得的证据极为重要。在短短的十几年间,循证医学给心血管疾病的临床实践带来了根本的变化。     

中医药学将走向何方

由于中医缺乏形态学,中医没有成熟的科学实验,中医的诊断很难标准化、客观化,理论逻辑的致命弱点,理论体系难以重构,所以中医药学在很长一段时间内将保留下来之后,随着中医药学的理论体系的缺陷无法克服,原有的中医药体系必然解体,其中有部分内容融入现代医学。中医药学的归宿就是逐渐融入现代医学。