知情同意的临床实践存在的问题及对策

临床医疗实践中贯彻实施知情同意原则旨在保护病人的权益不受侵犯,然而知情同意原则实施起来并不简单,它常常会受到主客体两方面种种因素的制约,陷入意想不到的困境。分析了知情同意原则在实施过程中可能出现的一些难以回避的问题,并针对这些问题探讨了若干对策。     

SARS反思:我国卫生资源宏观分配中存在的几个问题

此次应对SARS的历程昭示我们,我国卫生资源宏观分配存在严重问题。主要表现在：政府卫生总投入严重不足;政府卫生资源在治疗和预防之间的再分配不合理;政府卫生资源的城乡分布极不均衡。我国应该从这次对抗SARS的战役中吸取教训,努力改变这种不合理的局面,提高我国应对各种疾病特别是各种传染病的能力,增进我国人民特剐是农民的健康水平。     

医疗风险防范与化解新趋向

新的《医疗事故处理条例》实施以后,患者的自我保护意识不断增强、高精尖医疗器械的应用、新技术的不断开展等均增加了医疗行为的风险,医疗风险管理显示出日益重要的作用。新形势下医疗风险管理的新趋向是建立自愿的医疗责任保险、组织患者参加医疗风险保险、建立强制性医疗责任保险制度、卫生行政部门代理保险业务、建立医疗援助基金等方式,提出了在风险控制的基础上,加强风险融资的措施。     

Medical student dreams about medical school: The unconscious developmental process of becoming a physician

This paper is a report on a collection of almost four hundred dreams of medical students and postgraduate trainees with the manifest content about medical training. It is a unique dream collection from a defined population that experiences a developmental sequence of observable, reality events. The reality events appear in the manifest content of the dreams along with their symbolic alterations. The dreams are used as a psychodynamic database. The data may illustrate which reality experiences seem psychologically formative, their emotional developmental sequences and their specific emotional content. This is a pilot project exploring whether dream material collected from a discrete task group might give information about a group's emotional adaptation. The dreams seem to show an unconscious developmental process in response to medical training and becoming a physician that unfolds in overlapping stages as trainees learn to master skills and tolerate care-giving responsibility for human life. A progressive, unconscious hero-healer fantasy seems to form. It becomes elaborated in masochistic and then sadistic fantasies. These fantasies are evoked by, and used as a defense against, inevitable but painful anxieties of emotional adaptation to medical education experiences.     

Ritual in Western Medicine and Its Role in Placebo Healing

Ritual has long been thought to play an important role in the healing processes used by ancient and non-Western healers. In this paper, I suggest that practitioners of Western medicine also interact with patients in a highly ritualized manner. Medical rituals, like religious rituals, serve to alter the meaning of an experience by naming and circumscribing unknown elements of that experience and by enabling patients' belief in a treatment and their expectancy of healing from that treatment. These are all critical elements necessary to mobilize the potent placebo effects reported elsewhere to result from doctor-patient interactions.     

猝死、医疗纠纷与尸体剖检

貌似“健康”的人突然死亡(即猝死),由于事先无任何预兆,出乎人们意料往往使人们对死因产生怀疑,若死者是在因病就医过程中突然死亡,特别是在刚注射或服药后死亡,很容易被认为是医护人员的医疗活动及其相关活动有问题而引发医疗纠纷,每位医务人员应高度重视,若死因不明,尸检则是解决这一棘手问题的关键。     

Publication standards in infancy research: Three ways to make Violation-of-Expectation studies more reliable

The Violation-of-Expectation paradigm is a widespread paradigm in infancy research that relies on looking time as an index of surprise. This methodological review aims to increase the reliability of future VoE studies by proposing to standardize reporting practices in this literature. I review 15 VoE studies on false-belief reasoning, which used a variety of experimental parameters. An analysis of the distribution of p-values across experiments suggests an absence of p-hacking. However, there are potential concerns with the accuracy of their measures of infants’ attention, as well as with the lack of a consensus on the parameters that should be used to set up VoE studies. I propose that (i) future VoE studies ought to report not only looking times (as a measure of attention) but also looking-away times (as an equally important measure of distraction); (ii) VoE studies must offer theoretical justification for the parameters they use, and (iii) when parameters are selected through piloting, pilot data must be reported in order to understand how parameters were selected. Future VoE studies ought to maximize the accuracy of their measures of infants’ attention since the reliability of their results and the validity of their conclusions both depend on the accuracy of their measures.     

新型农村合作医疗制度进一步发展的瓶颈分析

提出制约新农合制度发展的瓶颈有：筹资方式及筹资成本问题、筹资水平、补偿内容的设计问题、过多照搬了城镇职工基本医疗保险的资金管理方式、管理能力与管理手段、位于卫生局内的合管办、无法实现“解决因病致贫、因病返贫”的政策目标。     

Do details bug you? Effects of perceptual richness in learning about biological change

People often have difficulty in understanding processes of biological change, and they typically reject drastic life cycle changes such as metamorphosis, except for animals with which they are familiar. Even after a lesson about metamorphosis, people often do not generalize to animals not seen during the lesson. This might be partially due to the perceptual richness of the diagrams typically used during lessons on metamorphosis, which serves to emphasize the individual animal rather than a class of animals. In two studies, we examined whether the perceptual richness of a diagram influences adults' learning and transfer of knowledge about metamorphosis. One study was conducted in a laboratory setting, and the other was online. In both studies, adults who saw the bland diagram during the lesson accurately transferred more than adults who saw the rich diagram during the lesson.