我们时代的境遇——临床诊疗行为中的医患文化冲突

就临床诊疗工作中的医患文化冲突问题,从何谓文化冲突、它的行为表现、文化冲突的原因等方面进行了探讨,从认知、情感、社会心理、环境变迁、价值观多元等社会文化的层面来认识和分析医患之间的复杂关系,并就正确看待和弱化医患文化冲突提出了意见。     

Chapter 3 Integrative Short-Term Treatment of the Borderline Patient

Abstract

The realities of current practice necessitate that clinicians engage in briefer forms of treatment with borderline patients despite the fact that long-term treatment has been considered the treatment of choice because of their entrenched and pervasive personality difficulties, severe developmental arrests, and history of trauma. Most short-term treatment models are ill-suited for work with the borderline population because they favor highly motivated and well-functioning patients who have circumscribed problems. Nevertheless, there is a considerable body of practice principles that can be adapted to brief treatment with borderlines. This paper reviews the clinical features of borderline disorders and current views on their origins and treatment and then describes the components of an integrative short-term treatment framework.     

台湾地区姑息医学制度的建立及法律实践

姑息治疗在提高晚期癌症患者生活质量、实施临终关怀、给予病人及其家属全面周到的照顾诸方面起着重要作用。在台湾,已为姑息治疗立法并实施了10年,积累了丰富的经验。这项法律本身及其细则、附件等配套文件使姑息治疗更加规范可行。研究规范的姑息治疗及台湾的相关法律可以帮助我们更好的理解姑息治疗的理念,帮助发展大陆同道构建有效实用的...     

知情同意权中的哥德巴赫猜想--知情权与患者认知能力之间的冲突

知情同意权作为医患关系中患者一方最基本的权利正受到患者认知能力的严重影响。这一方面是原本专业化医学正在逐步走向专门化原因造成的,但与医患关系,文化传统,知识水平等因素也有千丝万缕的联系,正确处理知情权与患者认知能力之间的关系对于衡平医患关系,维护医患双方权益有着重大的现实意义。问题既有赖于医患双方的协力;更要依靠社会各方面合作,形成合力加以解决。     

社会工作视野下构建和谐医患关系的策略分析

和谐的医患关系是一切医疗活动的基础。面对当前医患关系中的不和谐现象,不同学者对其形成的原因及其对策进行了多学科的探索。作为一种以利他主义为指导的专业助人服务活动,社会工作则提供了一种介入医疗纠纷问题的崭新视角。在协调医患关系的过程中,医务社会工作需要面向病患及其家属、医护人员、医院管理层、社会及大众媒体、政府公共卫生管理部门等不同的主体,发展出不同的工作策略,扮演不同的服务角色。     

老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群。为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗。以往,手术治疗和化疗的应用随着年龄的增高而明显减少。我们一直以为老年人手术和化疗的效果不令人满意。近期的研究改变了这一认识。证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的。即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益。所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效。腹腔镜下结肠癌根治术是对老年人安全有效的手术技术。我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益。     

The New Biology and its Impact in Biomedical Strategies Against HIV/AIDS

Abstract. The sequencing of the human genome and the initiation of the structural genomics projects have ushered in a new age of biology that involves multi‐lab, high‐cost projects with broad task‐oriented goals rather than the more conventional hypothesis‐driven approach of the past. The new biology has led to the development of new sets of tools for the scientist to use in the quest to solve mysteries of human disease, biomolecular structure‐function relationships, and other burning biological questions. Nevertheless, the impact of the new biology on the field of AIDS investigation has been minimal, predominantly because many of the tools in the HIV field of study were developed before the full advance of the new biology was felt in the biomedical community. Many of the high‐cost megaprojects that involve large technological advances and are marketed as projects of promise to the biomedical community are not likely to significantly impact the field of HIV/AIDS research and cannot serve as a substitute for direct funding to the HIV/AIDS scientists working for vaccine development, an understanding of mechanisms of disease causation, and new tools for therapeutic intervention.     

Meta-analysis of CBT for Bulimia Nervosa: Investigating the Effects Using DSM-III-R and DSM-IV Criteria

This meta-analysis reports the effects of cognitive-behavioural treatment (CBT) on bulimia nervosa as defined by the DSM-III-R or DSM-IV criteria. In a previous meta-analysis, 26 studies were included using less strict diagnostic criteria for inclusion. The present meta-analysis only included randomized controlled studies fulfilling the DSM-III-R or DSM-IV criteria. Computer searches in MedLine, PsychLIT and references cited herein resulted in a large number articles, of which only seven fulfilled the criteria for inclusion. Effect sizes for binge eating and purging frequency were estimated using both between-group (treatment vs control) and within-group (pre- vs post-treatment) comparisons. The combined within-group effect size for binge eating was r = 0.55 ( d = 1.32) and for purging r = 0.61 ( d = 1.54). The corresponding combined effects for the between-group comparisons were r = 0.23 ( d = 0.47) and r = 0.28 ( d = 0.58), respectively. The combined probabilities for frequency of purging in between- and within-group comparisons were p = 0.00001 and p = 0.00000001, respectively. Although the number of studies included in the meta-analysis was limited, the obtained results are in line with the findings of the previous meta-analysis, and support the efficacy of CBT for the treatment of bulimia nervosa. This suggestion is also supported by the fact that in all the studies except one, comparison groups had received other active treatments.     

末期癌症患者的临终关怀

临终关怀与末期癌症关系密切,末期癌症患者是临终关怀的主要对象,这也是姑息医学的主要内容。作为发展中的学科,本文对临终关怀的发展、目的、内容及其在末期癌症患者中的实施作一综述。     

Patient and Family Descriptions of Ethical Concerns

Abstract

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants (N?=?196) described 219 unique ethical experiences that spanned many of the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting.