Medical education: The training of ethical physicians

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.I wish to thank Dr. Mary Ann Cutter and Melissa M. Amaro for their critical suggestions.     

The Future of Neuropsychology in Medical Specialties

Although neuropsychology continues to grow as a valued service in most medical specialties, because of its multiple uses with diverse populations, it is necessary to evaluate the specialty critically in order to ensure continued future success. This article reviews areas in which neuropsychology is most firmly established, potential growth areas, and likely obstacles to success in the future. Suggestions are provided for ways in which neuropsychology can be improved/adapted in clinical, business, research, and training areas. On sabattical at Bebek University, Instanbul, Turkey     

Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

Exploring the set-theoretical structure of objects by additive trees

Arrangements of feature sets that have been proposed to represent qualitative and quantitative variation among objects are shown to generate identical sets of set-symmetric distances. The set-symmetric distances for these feature arrangements can be represented by path lengths in an additive linear tree. Imperfect versions of these feature arrangements are proposed, which also are indistinguishable by the set-symmetric distance model. The distances for the imperfect versions can be represented by path lengths in an additive imperfectly linear tree. When dissimilarities are defined by the more general contrast model and a constant may be added to proximity data, then for both the perfect and imperfect arrangements an additive tree analysis obtains a perfect fit with an imperfectly linear tree. However, in the case of the contrast model also the distinction between the perfect and imperfect arrangements disappears in that also for the perfect arrangements the resulting tree need no longer be linear.The author is grateful to Mathieu Koppen for detailed comments on an earlier version of this article.     

医学伦理学概念之探究

医学伦理学的概念看起来很简单,一般情况下人们便习以为常地接受了作为应用规范伦理学的一个分支的科学地位,而忽视了医学对医学伦理学所起的作用。本文认为：医学伦理学的具体内容是医学科技与伦理道德两因素相互作用的产物,对其相互作用的形式和产物的具体分析和总结便可构成这门学科的理论体系。     

Role of the striatal cholinergic system in the regulation of learned manipulation in rats

The experiments were performed on adult Wistar male rats trained to push with the forepaw on a fixed piston inside a narrow tube. It was found that after localized intracerebral injection of a cholinergic antagonist into the dorso-lateral (but not medial) neostriatum (i.e., the caudato-putamen) the behavioral performance requiring brief innate movements remained unchanged, but the performance requiring a prolonged pushing movement (> 50 msec) became disrupted. Microinjection of carbacholine (0.03-3 μ g/1 μ1) did not affect the performance of the acquired movements, whereas scopolamine (3 μ g/1 μ1) led to the significant decrease in pushing time. We conclude that changes in the state of the dorso-lateral neostriatal cholinergic system result only in disturbances of the sensory-controlled component of a complex instrumental movement. The 1994 Pavlovian Society Young Investigator Awardee was Nadezda Dubrovskaya, first author of this paper, which was presented at the annual meeting of the Pavlovian Society, July 3, 1994, in Prague, Czech Republic.     

Evaluating children's mental health service systems: An analysis of critical behaviors and events

A lack of studies which evaluate system change by tracking client outcomes is noted in the children's mental health area. This deficit may be a result of the inability of researchers to define outcomes and to draw conclusions about which measures reflect the efficacy of services and service delivery systems. This paper reviews five social validation surveys which examined children's mental health outcome measures. Based on the results of the five surveys, a model of critical behaviors and events is presented. This model will assist evaluators and researchers in understanding which critical events and behaviors should be measured to assess the impact of community-based mental health services for children.     

THE TREATMENT OF COVERT SELF-INJURY THROUGH CONTINGENCIES ON RESPONSE PRODUCTS

Assessment and treatment of covert self-injurious behavior are complicated because it is difficult to quantify and apply differential consequences to covert responses. In this study, both tangible and social reinforcers were identified using reinforcer assessment methods. These reinforcers were then provided contingent upon the absence of tissue damage identified during physical examinations, resulting in near 100% success in physical assessment checks that was maintained over 10 months.     

Sensitizing Medical Residents to Fantasies and Alignments in the Family: Mastering Psychosocial Skills in the Medical Encounter

In this paper, it is proposed that a) psychosocial medicine is best taught in a setting that provides technical and emotional support, while seizing for teaching only those moments when the learner is most receptive; and b) that the setting should avoid the development of a separate psychosocial skills curriculum, but should take the student where he or she is and integrate the psychosocial skills into his or her everyday biomedical practice. The paper gives specific case examples in which family based psychosocial issues were preeminent in the clinical problem-solving medical residents faced.