Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.     

基于微信平台的研究生积极心理干预

积极心理学提出三件好事(three good things,TGT)练习可有效减轻抑郁症状,提升幸福感和心理健康。为检验基于微信社交平台的“三件好事”练习(TGT-SN)能否提升幸福感,本研究招募北京某高校研究生232名,自愿加入三个被试组(TGT-SN组133人,TGT组53人,对照组46人),体验、评估40天TGT前后及干预后一个月幸福感、抑郁水平、人际关系以及干预效果。研究发现抑郁得分持续改善,其他问卷得分无显著差异,但被试自评干预效果评估确认练习有积极作用。TGT练习效果有限,涉及方法有效性、样本量、参与者动机以及外部影响因素等,未来可基于优秀传统文化开展进一步研究以提高被试依从性及主动健康行为。     

Medical Psychology in Greece

The country of Greece is described, and the academic and professional requirements for licensure as a psychologist are reviewed. Several contentious professional issues are reviewed, and the paper describes the major professional associations to which Greek psychologists belong. The practice of psychology in medical settings is emphasized, and the relationships between psychology and psychiatry are reviewed.     

循证医学指导医疗实践

循证医学的发展强调医疗决策物制定应将个人的临床经验与现有的最可信的临床研究证据进行完善结合。促进了医学模式的转化,对医疗实践起指导作用。现就循证医学对心血管病临床实践的指导作用的必要性和可能性及其内容作一简述。     

医疗过失的法律责任

引起医疗纠纷的事实可分为应由医方承担责任的事实和不应由医方承担责任的事实,只有医方符合法律责任的构成要件－即医疗行为的主体是医疗单位、主体有过失或违反义务的行为、有损害后果、而且主体的行为与损害后果之间有因果关系,才需承担法律责任,以消除只有损害后果医方就要承担法律责任和只有鉴定为医疗事故的才承担法律责任等方面的误区。     

21世纪医学教育的知识结构初探

在知识爆炸的今天,个人全面系统掌握医学基础知识只能是一个幻想,新世纪要求有关教育知识结构的变革。继续延用经典医学学科多平层型知识结构进行21世纪医学教育已不适应,可满足需求的应是以可持续发展的新知识为核心的核心－壳层型新知识结构。目前似应以细胞知识为核心重组医学教育知识结构体系,按应用基础、临床等知识壳层对冗杂的经典学科知识进行精炼与重组。     

Treating Depression in Older Medical Patients with Psychotherapy

This purpose of this paper is to discuss the effectiveness of psychotherapy for treating depression in older, primary care patients. This paper highlights the feasibility of implementing psychotherapy in primary care settings, patient preference for psychotherapy, and the utility of primary care versions of therapy in treating depression in older adults. The discussion is supported with examples from three ongoing research projects, specifically the San Francisco General Hospital Depression in Late Life Study, the Hartford Foundation/California Healthcare Foundation IMPACT study, and the NIMH PROSPECT study. The findings presented here support the value of offering psychotherapy as a treatment alternative in primary care medicine.     

知情同意与保护性医疗制度的思考

为了提高医务人员尊重患者知情同意权的法律意识和建立人文医疗的服务理念,促进医学伦理和医事法律建设的进程,对医疗活动中如何理解和落实知情同意与保护性医疗制度等问题进行了比较分析。目前,在如何调节知情同意与保护性医疗的矛盾方面缺乏明确的法律依据,因此,尊重患者的合法权益不仅体现医德和对生命的尊重,同时对于人文医疗与医患和谐有着积极的促进作用。     

佛山市急性阑尾炎住院费用比较分析

对医保与非医保患者费用进行比较,分析医保病例的费用特点及相应的费用控制办法。采用协方差分析和秩和检验分析两组患者的费用情况。结果显示,在急性单纯性阑尾炎治疗费用上,医保患者的费用高于非医保患者。提倡政府应加强对医疗费用的监督,改革供方支付方式,建立公平竞争的医疗市场机制等。     

患者亲属——医疗决策的重要主体

在医患关系中,患者亲属起着重要作用,是医疗行为及后果生理和心理的承担者,患者的疾病本身和康复情况会直接对家庭生活产生影响。患者亲属也是患者医疗费用的主要承担者。由于医疗决策会涉及到患者的家庭利益,患者患病会对其决定能力产生不利的影响,在法律上确立患者亲属在医患关系中的主体地位,甚至在必要时赋予亲属医疗决定权是必要的和现实的。