老年糖尿病患者人工髋关节置换术的围手术期处理体会

探讨老年糖尿病患者人工髋关节置换术围手术期的治疗方法。对2000年1月~2006年3月54例糖尿病患者行人工髋关节置换术进行术后随访,利用临床关节功能及放射学检查进行分析。54例手术患者血糖控制满意且顺利度过围手术期。按Harris评分标准,术后髋关节功能优良率分别为人工股骨头置换组74%(14/19),人工全髋关节置换组91%(32/35)。未发现感染及假体松动现象等并发症。老年糖尿病患者如果有髋关节置换手术指征,没有严重的并发疾病,在重视围手术期处理的情况下,可以行人工髋关节置换术,且疗效肯定。     

我国肢体残疾病人矫形治疗的现状分析

我国肢体残疾病人的发病率、病种分类、病情特点、医疗需求的实际情况如何?矫形外科医生队伍的建设与学术研究现状怎样?众多的肢体残疾者是否得到正确的矫形外科治疗?骨科学术界缺乏这样的分析。作者实施了2万多例各种肢体残疾的矫形手术,对其中16678例病人进行了统计分析,结果发现,近10余年来我国大医院进入以市场为主导的发展阶段,外科治疗下肢畸形与残疾的矫形外科专业,由于缺乏强大的市场推动、治疗过程较复杂等原因,而被忽视。我国矫形外科医师严重缺乏,某些下肢残缺的矫形手术治疗甚至人才断档。从而出现数以百万计的各种肢体残疾病人,因为缺少经济能力和矫形外科医师,没有得到正确的矫形外科治疗。作者分析了我国肢体残疾病人的发生率、病种、病情特点、年龄分布、经济状况和医疗需求,提出了解决这一问题的对策和建议     

是否告知重症患者病情的调查

本调查认为:目前多数人仍主张不将病情如实告知重症患者.我们应当清楚实情告知重症患者病情所面临的困难和患者知情同意权行使时的障碍,从而缩短社会承认医生告知的过程.     

代理行使知情同意权的有关问题探讨

代理行使知情同意权在医疗实践中广泛存在,也面临一些争议。对代理权设置的法律意义、代理行使知情同意权在医疗实践中的种类以及不同情况下的问题与对策作出分析,为这个领域的代理实践提供一些思路。     

To Be With Them: A Hospital Chaplain's Reflection of the Bedside Ministry to Terminally III and Dying People

The author, an ordained Lutheran pastor, reflects upon his experiencesas chaplain at a small hospital in southwestern Germany (Tropenklinik– Paul Lecher Krankenhaus, Tübingen). Besides itsexpertise in the treatment of tropical diseases this 100 + bedhospital serves as the referral hospital for terminally illand dying patients from the local University hospitals and thesurrounding area. The experiences at the bedside of such patientswith various denominational and religious backgrounds challengedthe chaplain to go beyond the confines of any fixed theologicalsystem or counseling technique. They made him to discover threeessentials as the very basis of such ministry, which he sharesin this article. He identifies these as (1) the necessity torealize the situation sober mindedly, (2) the desire to becomea companion, and (3) the venture of confident faith, where holdingon to any genuine perspective of life is deemed ridiculous.     

TERMINATION OF A FE/MALE TRANSSEXUAL PATIENT'S ANALYSIS: AN EXAMPLE OF GENERAL VALIDITY

The author describes the termination of an analysis, which, while relating to the particular case of a male-to-female transsexual patient, may be relevant to all analysts, particularly those whose patients need to integrate disavowed and split-off parts of themselves. The patient had undergone sex-change surgery at the age of 20. Having lived as a woman thereafter, she had asked for analysis some twenty years later. The author, who discussed the first three years of that analysis in an earlier paper, as well as her hesitation about undertaking it, considers that its termination after seven years illustrates not only the specific problems posed by transsexuals but also the general ones presented by 'heterogeneous patients'. To the best of her knowledge, this is the first published case history of a transsexual patient who has undergone surgery. In the author's view, the patient has acquired a new sense of internal unity based on a notion of sex differentiation in which mutual respect between the sexes has replaced confusion and mutual hate, and her quality of life has improved. On the general level, this termination shows how the reduction of paranoid-schizoid anxieties and the reintegration of split-off parts of the personality lead, as the depressive position is worked through, to a better toleration of internal contradictions, a new sense of cohesion of the self and a diminution of the fear of madness.     

海洛因戒治者执行控制功能异常的电生理证据

执行控制障碍是成瘾的核心特征之一,对成瘾者的复发与康复治疗有重要影响。采用事件相关电位(ERP)技术分析海洛因戒治者和健康成年人在经典色-词Stroop任务中执行控制的大脑皮层时程动态变化。行为结果发现,两组被试的反应时均有显著的Stroop干扰效应,但无显著组间差异。ERP结果显示,戒治组不一致条件的平均波幅显著小于对照组;戒治组Stroop任务相关的N2效应和SP消失及N450效应衰减。研究结果表明,海洛因戒治者可能存在早期冲突监控加工障碍和晚期反应冲突解决加工异常。     

科学分析临床试验结果维护公众健康

近20多年来,循证医学对推动我国疾病访治的科学化、规范化和现代化起到了积极推动作用。但以临床试验为基础的循证医学在我国的20年历程也出现了一些值得关注的问题。本文将向临床医生提供如下信息：如何正确分析临床试验结果,如何合理地将临床试验结果用于临床,以及如何向患者传递科学的医学信息,保护患者利益。