关注人文素质教育语境下的中医医史文献

随着社会的发展及医学模式的转换,人们呼唤重新审视医学的目的和价值,期待着医学人文关怀传统的复兴。于是,加强医学院校大学生人文素质教育,倡导人格教育理念,成为医学院校加强素质教育的重要内容。中医医史文献教育教学的视角,分析素质教育语境下的专业教育问题。     

Longitudinal interplay of young children's negative affectivity and maternal interaction quality in the context of unequal psychosocial resources

Interaction quality and child temperament predict early and later child development. Research hints at transactional interrelations of both aspects but lacks adequate data to examine this assumption. Maternal psychosocial resources are suspected moderators in this context but rarely taken into account. Drawing on data of the German National Educational Panel Study we conducted a cross-lagged panel analysis on the longitudinal interplay of maternal interaction quality and children's negative affectivity at 6–8, 16–18, and 25–27 months and compared mothers with and without accumulated strains. Both variables showed moderate to high structural and rank order stability over time and low but increasing connections. In the case of accumulated stress factors, interaction quality is clearly impaired and high negative affectivity acts as an additional burden while low negative affectivity helps strained mothers to maintain higher interaction quality but only in the first year of life.     

安宁疗护患者生活质量评估工具的研究进展

准确评估临终患者的生活质量能更好地实施和评价安宁疗护。国内外相关评估工具各有特点,国外相关研究较为成熟,已有较完善且应用广泛的评估工具;而我国此方面的研究起步较晚,相关工具数量少且应用局限。介绍了国内外安宁疗护患者生活质量评估工具的发展过程、适用对象、测量内容、信效度以及使用方法,并对各工具的基本情况和应用现状进行比较分析,以期为临床研究选用合适的评估工具、国内学者汉化及开发相关评估工具提供参考。

     

医疗质量模糊性特征研究

探讨医疗质量的特性,通过系统经验分析法,认为医疗质量具有模糊性特征,难以辨别优劣,导致卫生行政部门、医疗机构忽视提高医疗质量。行政部门应加强医疗技术管理,推行医院法人治理结构制度,做好信息公示。医疗机构也应加强服务过程管理,培养医护人员人文精神,落实规章制度,推行临床路径管理,减少医疗差错,加强医院感染管理,医护人员也应加强责任心,多方努力才有可能提高医疗质量、保障患者安全。     

技术创新对提高医疗服务质量驱动力的探析

技术创新在人类发展史上起着里程碑式的作用,同样推动现代医学快速进展和持续进步。医疗技术是医疗质量的核心,技术创新能够全方位提升医疗服务质量。结合国内外医疗相关技术创新的现况和医院实践,剖析了技术创新在提升医疗服务质量中的驱动作用,结合自身实践,从医疗设备技术创新、医学信息技术创新、医学技术创新思维和理念这三个方面,对技术创新促进医疗服务质量提升的实现途径进行探讨,为持续改进和不断完善医疗服务质量提供新的思路和手段。     

The role of anxiety sensitivity in the relationship between posttraumatic stress symptoms and negative outcomes in trauma-exposed adults

Background: The development of posttraumatic stress symptoms (PTSs) following a trauma is related to impairment, diminished quality of life, and physical health issues. Yet it is not clear why some trauma-exposed individuals experience negative outcomes while others do not. The purpose of this study was to determine the role of several influential factors related to PTS severity and negative outcomes. Methods: One hundred and twenty-two trauma-exposed adults were administered the following self-report measures: the Posttraumatic Stress Disorder Checklist-Civilian, the Trauma History Questionnaire-Short, the Anxiety Sensitivity Index-3, Depression and Anxiety Stress Scale 21, Sheehan Disability Scale, World Health Organization Quality of Life-BREF, and an abbreviated Patient Health Questionnaire. Primary Results: PTS severity was positively correlated with depressive symptom severity (r = 0.54, p < 0.001), chronicity of the most distressing trauma (r = 0.21, p = 0.017), and number of traumas (r = 0.22, p = 0.012). Main effects were found for PTS severity (β = ?0.38, p < 0.01) and anxiety sensitivity (AS; β = ?0.39, p < 0.01) on quality of life. No interaction was found between PTS severity and AS with any negative outcome. PTS severity mediated the relationship between AS and physical health issues (0.05; 95% CI: 0.02–0.08). Conclusion: This study helps clarify the role of various factors in the relationship between trauma and negative outcomes. Clinical and research implications are discussed.     

Conflict Buffers and Marital Satisfaction: On the Effects of Different Forms of Social Support

This paper deals with the deterioration in the subjective quality of life of women as a result of marital conflict. Whereas primary and secondary prevention are generally targeted at maintaining or increasing the current level of marital happiness this paper focuses on the possibilities for buffering the negative impact of conflict on women’s quality of life. In particular, this paper is interested in the conflict buffering effects of various forms of social support such as home visiting by professional social workers or informal contacts with peers. In order to assess and compare the effectiveness of these forms of tertiary prevention, data from interviews with young mothers in the city of Zurich (Switzerland) will be reanalyzed. The data confirm the phenomenon of stress buffering from social support and reveal variation with regard to the effectiveness of different stress buffers. Female peer support e.g. seems to be at least as successful as home visiting by professional nurses and social workers.     

A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

Factors Moderating Children's Adjustment to Parental Separation: Findings From a Community Study in England

Research findings show that there is marked variability in children's response to parental separation, but few studies identify the sources of this variation. This prospective longitudinal study examines the factors modifying children's adjustment to parental separation in a community sample of 5,635 families in England. Children's behavioral/emotional problems were assessed when children were aged 47 and 81 months; marital quality, maternal depression, socioeconomic circumstances, and demographic variables were assessed prior to the separation from maternal report. Results indicated that 346 mothers separated from their partners in the 3-year period. Preseparation differences were found for measures of family process and parent risk factors, with effect sizes ranging from small to trivial. Parental separation was associated with a significant but modest increase in behavioral/emotional problems, independent of marital quality, maternal depression, socioeconomic circumstances, and demographic variables. Moderation analyses showed that children of cohabiting parents had a greater increase in adjustment problems following parental separation than children of married parents. Further research elucidating the factors that moderate children's adjustment to parental separation is needed to improve our understanding of who may most likely benefit from preventive interventions.