病人自主性与家庭本位主义之间的张力

在中国几千年小农经济和传统文化背景下,个人利益、个人权利一直被置于家庭之下,个人自主性被包含在家庭自主性之内,表现为一种家庭本位主义。源自西方历史、文化的知情同意移植到中国后,受传统文化观念的影响,中国人对知情同意的认知、理解以及实践方式均不同于西方人。这种不同集中表现在人们对家属同意权的认可。以个人本位主义为背景的病人自主性与中国文化中的家庭本位主义之间存在张力。对知情同意在不同文化环境中不同践行方式,应以文化宽容主义的态度对待之。     

和谐医患关系建构中患者的道德责任

患者具有正常的理性自觉能力决定了其应当承担相应的道德责任。导致患者在医患关系中失责的原因在于患者的病人角色意识强化了患者无责的心理,制度设计中价值标准失衡导致患者的愿望错位以及媒体“妖魔化”医院和医生的形象加剧了患者的对医疗机构的不信任情绪。患者在和谐医惠关系建构中应当承担的道德责任主要有：提高认知水平,尊重医学技术发展规律和医护人员的劳动,宽容对待具体情境中的问题。     

论医护人员对患者隐私权保护的注意义务

侵害患者隐私权的医疗纠纷频发,很大原因是医护人员未履行对患者隐私保密的高度注意义务。从具体案例出发,就医护人员对患者隐私权保护的注意义务进行阐释,探究该义务产生的根源,对违反该注意义务的责任进行评析。以期提高医护人员对患者隐私权保护注意义务的重视,减少相关医疗纠纷的发生。     

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。     

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.     

论医学人文精神的历史走向

医学人文精神和医学科学精神的整合交融,是医学走向成熟的标志,对生命的终极关怀,是医学人文精神的基本内涵;对医患关系的理解和介入方式,是医学人文精神切入实践的关键;医学人文品格是医学人文精神的良性载体和职业表征。是医生理想的职业人格。这四个问题从不同角度,不同层面凸现了医学人文精神的实质,反映了在新医学模式背景下医学人文精神的历史走向。     

THE EFFECTS OF REARRANGING WARD ROUTINES ON COMMUNICATION AND EATING BEHAVIORS OF PSYCHOGERIATRIC PATIENTS

Several aspects of ward routine were changed to study the effects of environmental manipulation on the behavior of 21 psychogeriatric patients. Furniture was rearranged to be more conducive to conversation (i.e., grouped around tables instead of along corridor walls), and mealtime routines were changed to allow patients more time to eat, more freedom in choosing the composition of the meal, and more pleasant surroundings. Patients were divided into experimental and control groups, and data were collected on the frequency of verbal and tactile communication and degree of skill in eating behavior. Following baseline, environmental changes were introduced across behaviors. Results show that the frequency of communication increased for the experimental group, as compared to both baseline and the control group. Eating behavior also improved significantly for the experimental group. The study shows that minor changes in the physical environment can promote therapeutic change in the behavior of patients diagnosed as senile dementia.     

Behavioral assessment of psychiatric inpatients and normal controls across different environmental contexts

Objectively defined, publicly observable behaviors were time sampled for hospitalized psychiatric patients and normal controls in three distinct environmental contexts: lunch time, free time, and gym time. The behaviors sampled included body activity, extremity activity, proximity, social interactions, participation, visual scanning, laughing/smiling, and idiosyncratic behavior. Patient behaviors were recorded during both a drug-free baseline period and a subsequent medication period. The data suggest that consistent and reliable differences between patients and normals in most behaviors can be observed and that environmental context is an important determinant of these differences. Results are discussed in terms of their implications for assessment procedures and treatment decisions.These investigations were supported in part by State of Illinois Department of Mental Health and Developmental Disabilities Grants RD836-13 and RD622-02 to the first author. The cooperation of the Illinois State Psychiatric Institute staff is gratefully acknowledged.     

Renewal of object relations through dream-work

In this paper I describe my work with a suicidal patient. The patient was a woman who failed to realize her creative potential in a much wished for and unattainable profession of teacher and transferred all her energy and desire for leadership into her family life. The slogan of her life was the pathetic phrase: 'Everything or nothing!' Her views on life differed from those of her husband who, at the age of 48, started a love affair with a 25-year-old woman. In relation to this, the patient became depressed and attempted suicide twice (by poisoning) in two years. From the Toxicology Department she was referred to the Psychiatric Department where she was treated as an out-patient.     

IMPROVING SOCIAL INTERACTION IN A CHRONIC PSYCHOTIC USING DISCRIMINATED AVOIDANCE (“NAGGING”): EXPERIMENTAL ANALYSIS AND GENERALIZATION

Three social-interaction behaviors of a withdrawn, chronic schizophrenic were increased using a discriminated avoidance (“nagging”) procedure. The three behaviors were: (a) voice volume loud enough so that two-thirds of his speech was intelligible at a distance of 3 m; (b) duration of speech of at least 15 sec; (c) placement of hands and elbows on the armrests of the chair in which he was sitting. “Nagging” consisted of verbal prompts to improve performance when the behaviors did not meet their criteria. A combined withdrawal and multiple-baseline design was used to evaluate the effectiveness of the procedure, and the contingency was sequentially applied to each of the three behaviors in each of four different interactions to determine the degree of stimulus and response generalization. Results indicated that the contingency was the effective element in increasing the patient's appropriate performance, and that there was a high degree of stimulus generalization and a moderate degree of response generalization. After the patient's discharge from the hospital, the durability of improvement across time and setting was determined in followup sessions conducted at a day treatment center and at a residential care home. Volume and duration generalized well to the new settings, while arm placement extinguished immediately.