Family Physicians and Family Therapists: Understanding the Interdependent Synergism

This article, written by a family physician and a family therapist, is designed to identify differences between these two cultures that may serve as stumbling blocks to successful meeting of occupants of these two worlds. With the differences identified and described, various notions and suggestions are offered in an effort to promote more successful bridging between these two groups. There is little question about the synergistic impact that can be engendered for recipients of their care should this bridging be successfully navigated. The present day realities in healthcare make this an idea whose time has not just come, but rather seems imperative.     

Sleep, watchkeeping and accidents: a content analysis of incident at sea reports

The unique profession of seafaring involves rest and sleep in a 24-h-a-day work environment that usually involves time-zone crossings, noise, heat, cold and motion. Sleep under such conditions is often difficult to obtain, and sleeping and sleep loss are often related to fatigue and contributory to accidents. This study aims to determine how accident investigators report sleep in Incident at Sea Reports and subsequently analyse the relationships between sleep, fatigue and accidents in these reports.The full text of 44 Incident at Sea Reports was coded and analysed using NUDIST software. This sample included collisions and groundings reported since 1991, where significant human factors contributed to the incident. The Incident at Sea Reports were electronically searched for reference to sleep and content was indexed against parameters such as fatigue behaviours, time of day and contributing personnel. Incident at Sea Reports incorporate three levels of reference to sleep, analysis of which may associate sleeping and sleepiness with accident causation. The highest level of reference unequivocally associates either being asleep, or being sleep deprived with accidents, but not always with fatigue. At an intermediate level, reference to the conflicting pressures of work and sleep on board fishing boats and ships suggests a work environment that is not conducive to obtaining sufficient sleep, and accident investigators are usually unable to link the watchkeeping environment with fatigue as a contributing factor. At the lowest level of association, reference is made to the integrated nature of sleeping and work on board.     

蛇行在神秘与科学之间的服食炼丹

从中国思想文化大背景下考察古代医学的另一面,认为服食炼丹活动的兴衰是一个复杂的政治经济宗教道德的社会现象。古人肯定曾获过丹石之益,矿物药所含有的人体所需的微量元素与健康的关系会逐渐被现代医学所证明。人类在追求长生不老的过程中曾带来文化的交流,带动了医学、化学、药学、宗教、植物、矿物、饮食等方面的发展。人类医药学的发展史就是一部不断向“毒”宣战的历史。     

医学阐释学——医学哲学研究新视角

医学阐释学是哲学阐释学在医学领域的应用,是医学与哲学交叉的一个新领域。简述哲学阐释学的发展以及其主要观点,并集中讨论了医学阐释学研究的范畴,其中包括人体的现象学、健康和病患的意义、医患关系、生命伦理学、医学的目的。指出医学阐释学对医学哲学、医学人文科学研究的影响。     

发现问题是医学创新的起点

临床医学是一门充满着创造和活力的科学,而发现问题、发现特殊性,是临床医学创新的起点。     

文学疾病叙事的医患主体间性诠释

在人文医学领域,疾病叙事是患者与医者生命书写的一部分和建构自我主体性的叙事方法;文学史上的疾病叙事具有清晰的发展脉络,并逐步获得作为文学主题的独立地位。叙事医学的视角下,文学文本中的疾病叙事言说疾病的“不可见”维度,弥合“可见”与“不可见”的裂痕。以白先勇的两部短篇小说为样本,对文学文本中的疾病叙事做了具体的叙事医学阐释,说明其从对“不可见”的具身体验的言说走向肉灵跨越的身心救赎的丰富意蕴;同时指出过往疾病叙事中医者角色的缺席,提出利用文学文本疾病叙事建立医患主体间性。

     

良法善规和美德合力护卫医学初心

救死扶伤、防病治病、护卫民众的生命和健康、坚持医学人道主义是医学的初心,但当今社会,资本、技术、权力在特定条件下正在一步一步地扭曲医学的初心,资本在医学中逐步主体化,这正是医学初心面临挑战的根本所在,守卫医学初心必须从良法善规着手,从制度上保障医学初心,同时,良法善规必须以美德为辅佐,美德是良法善规的基础,也是良法善规的核心,正确使用权力是护卫医学初心的重要条件,美德伦理与规范伦理必须相互结合,相互补充,才能确保医学初心的落实。

     

古籍里的身体史：浅谈藏医体质学的发展及特点

藏医体质学在藏医药学文献中占有重要的比重。主要以历史为主线,分别以吐蕃时期的古籍文献《胸腔伤术论》《碧吉黄皮卷》《月王药诊》和佛教后弘时期的《二十支医学论典》,以及12世纪成书的《四部医典》等文献中所记载的不同体质学文献内容为研究对象,运用归纳法和对比法来探讨藏医体质学发展历程和不同体质分类方法,阐述了藏医学不同发展时期对体质的认知与文化结构差异等,即藏医体质学的分类法由三分法、四分法、五分法以及七分法的不同历程和独特的理论依据。

     

生活方式医学的演进与启示

系统梳理了美国、澳大利亚、英国三个典型国家生活方式医学的发展历程,其大致分为: 萌芽期、成长期、发展期。美国生活方式医学发展历史周期长,组织健全,课程开设和考试认证较为成熟;澳大利亚在协会成立和各种政策制定方面还不完善;英国在临床实践方面尚存缺陷。我国生活方式医学起步晚、发展缓慢,但发展空间大。鉴于此,本研究从依托政府政策支持和专业协会发展、健全人才培养体系、利用“互联网+”优化培训效果、与社区服务有机结合、同中医协同发展等方面提出建议,以期为实现我国生活方式医学教育可持续发展提供依据。

     

中医“金元四大家”的建构与不同历史书写

将刘完素、张从正、李杲和朱震亨并称为“金元四大家”,这种界定与元末明初儒士宋濂密切相关,但宋濂本人对金元四大家的认识并不固定,在其为不同医家撰写序文时呈现出不同的界定。同时期或后世的不同医家和儒者对金元四大家的界定也常有争议。“金元四大家”问题的提出,是在宋元以来中医儒学化的大背景下,儒士与医者重新梳理中医传承脉络,进而确认自身脉络坐标和传承正统性的需要。金元四大家的界定,与儒者对于医者的选择性褒扬,以及不同医家对于医学传承正统性脉络的不同认识相关,并不完全是医术的考量。