信任是改善医患关系的关键

目前医患关系紧张,医疗纠纷频繁,同时又是新闻媒体追逐的热点,追究其原因是医患之间的不信任。如果医患之间成为相互信任的朋友,医患之间多一些相互理解,医生掌握精湛的医术,具备良好的沟通能力,做一个充满阳光的常常带给患者乐观情绪、鼓励话语、轻松气氛的医生,加上医疗体制的改革,应该可以有效改善紧张的医患关系。     

如何避免卵巢良性肿瘤的过度治疗

卵巢肿瘤是妇科常见肿瘤之一,可分为良性、恶性、交界性肿瘤,及时处理卵巢良性肿瘤具有重要意义,但关于如何避免卵巢良性肿瘤的过度治疗,尚无定论。目前为止,关于卵巢肿瘤发生、发展机制的基础研究和诊疗技术正在取得较大的进步,对临床医师发挥着重要的指导和辅助作用。如何正确诊断卵巢良性肿瘤,如何选择合适的手术方式、实现个体化治疗,是避免卵巢良性肿瘤的过度治疗的关键。     

从技术创新看负压封闭引流技术的发展

负压封闭引流技术(vacuumsealing drainage,VSD)是近几年来发展起来的一项新的创口引流技术,其操作方便,应用简单,在临床各个科室得到广泛应用和发展,作者介绍了这一新的引流技术的发展历史、技术原理及临床应用情况。并对负压封闭引流技术的创新特点和创新方法进行了简要论述及展望。     

实现医学整合,满足门诊患者新需求——“一站式”多学科综合门诊

为了在门诊落实"一切以病人为中心"的服务理念,通过调查、了解病人的需求,改变传统的就医模式,将多学科整合,推出创新的"一站式"多学科综合门诊。改善了就诊流程,简化了就诊手续,对疑难杂症提供全方位、多学科综合诊疗,同时缩短患者就诊等候时间和多次往返各门诊的不便,减少就诊环节,实现医学整合,满足患者需求。     

医学院校自然辩证法教学中的例证探析

目前在《自然辩证法》的教学中还存在一些问题,如教材老化、师资力量不足,学生人文素质背景较薄弱等,为了切实使理论和实践相结合,使学生认识到该课程的重要性而学有所用,以医学院校为例,论述了如何将有关医学实例结合到《自然辩证法》的教学过程中去,以切实有效地提高这门课的教学效果。     

成人和婴儿麻疹临床特点和治疗

麻疹是一种急性呼吸道传染病,常见于6月～5岁儿童。近年来婴儿和成人麻疹患者在总患者数中所占比率表现出上升的趋势,容易造成误诊、漏诊。作为临床工作者,我们认为临床医生应充分认识到麻疹发病人群及年龄的改变,在临床工作中减少误诊,并为患者提供及时有效的治疗,对高危人群的有计划干预对于减低成人麻疹发病率有着重要作用。本文针对婴儿和成人麻疹的诊断和治疗进行了综述,试图提供参考。     

医护人员工作倦怠与A型人格、控制点的关系研究

通过对320名医护人员的调查,探讨工作倦怠与A型人格,控制点之间的关系。结果表明：(1)情绪疲惫、去人性化与A型人格、控制点存在显著正相关,个人成就感与控制点存在显著负相关。(2)A型人格、控制点对情绪疲惫,去人性化具有正向预测作用,控制点对个人成就感具有负向预测作用。(3)与B型人格相比．A型人格者的去人性化程度更高;与内控者相比,外控者工作倦怠程度更高。     

Physical characteristics of residential psychiatric and substance abuse programs: Organizational determinants and patient outcomes

Described the Physical and Architectural Characteristics Inventory (PACI), which assesses the physical characteristics of hospital- and community-based psychiatric and substance abuse residential treatment programs for adults. Developed using data from 94 representative programs, the PACI has 7 dimensions that assess community accessibility, physical features that add convenience, aid recreation, and provide support for patients, and space for patient and staff functions. In comparison to community-based programs (n=63), hospital programs (n=31) had more social-recreational and prosthetic aids, safety features, staff facilities, and space. The PACI dimensions were also related to other organizational features, such as facility ownership and program size and staffing level. Programs with more physical amenities had patients who were more involved in self-initiated and community activities and were more likely to successfully complete the program and be discharged to independent living situations and paid jobs. Programs with more social-recreational and prosthetic aids, space, and access to community resources also had better patient outcomes. In addition, PACI dimensions were related to observers' ratings of facility attractiveness. Potential applications of the PACI and the full inventory of which it is a part are discussed.     

两种医学模式的方法论问题评价

生物医学模式和生物心理社会医学模式是对医学发展具有重要意义的两种医学模式,它们在对疾病和健康的看法上形成不同的思维方式;且这种思维方式在人们进行医学科研中具有不同的方法论作用。     

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.