男性不育症诊疗中的伦理学思考

男性不育症是影响男性身心健康的重要疾患。生殖医学,特别是辅助生殖技术突飞猛进的发展,给男性不育症患者带来了福音,同时也给社会带来了许多伦理学问题。在工作中,医生应将伦理学原则与诊疗规范相结合,思考遇到的伦理学问题,自觉遵守医学伦理学规范。唯有这样,才能使生殖医学健康发展,才能保证患者最大程度受益。     

重症医学科医生心理健康的损害及其调控策略

重症医学科医生由于工作对象及工作环境的特殊性,心理健康容易遭受损害。从目前重症医学科医生心理健康损害的现状入手,陈述其心理健康损害的具体表现,分析产生其心理健康问题的常见原因,并从多个角度提出了解决其不良心理健康问题的调控策略。     

关于血管紧张素转换酶抑制药＋β受体阻断药组合的重新审视

采取联合用药方案治疗高血压已成为近年来临床用药的总体趋势。临床用药情况调查结果表明,血管紧张素转换酶抑制药＋β受体阻断药的联合用药组合占有一定的使用率,分析两类药的降压作用以及对高血压常见并发症和对代谢、心率等的影响,可见这个组合是合理的。     

表现性测验在能力评价中的应用

相对传统的纸笔测验形式,表现性测验的突出特点是任务的真实性水平较高。表现性测验是一种认知导向的测验。在国外教育、医学、心理咨询与治疗等领域的能力评价中,一系列表现性测验已被开发出来并用于实践,获得了较好的心理测量学指标。表现性测验可用于国内学生、教师的能力评价,辅助人才选拔以及相关职业资格认证的实践。表现性测验开发过程中若合理应用概化理论、项目反应理论等现代测量理论,对于提高测验信度和效度都有一定积极意义。     

POSSIBILITIES AND LIMITS OF MEDICAL SCIENCE: DEBATES OVER DOUBLE‐BLIND CLINICAL TRIALS OF INTERCESSORY PRAYER

Abstract. This article traces the intellectual history of scientific studies of intercessory prayer published in English between 1965 and the present by focusing on the conflict and discussion they prompted in the medical literature. I analyze these debates with attention to how researchers articulate the possibilities and limits medical science has for studying intercessory prayer over time. I delineate three groups of researchers and commentators: those who think intercessory prayer can and should be studied scientifically, those who are more skeptical and articulate the limits of science around this topic, and those who focus primarily on the pragmatic applications of this knowledge. I analyze these contests as examples of what Thomas Gieryn calls “epistemic authority” as medical researchers engage in what he describes as “boundary‐work” or “the discursive attribution of selected qualities to scientists, scientific methods, and scientific claims for the purposes of drawing a rhetorical boundary between science and some less authoritative residual non‐science.” (Gieryn 1999, 4 (Gieryn 1999, 4)).     

科学的划界与医学：—一论在医学中坚持科学精神

这里所论的科学划界标准是就自然科学而言的，区分科学与非科学最重要的标准是它的可检验性和可重复性。科学的这个划界标准今天并未过时，医学和一般自然科学相比有其特点，但其为实验科学的医学也应坚持这个标准。     

THE ‘OTHER 23 HOURS’: SPECIAL PROBLEMS OF PSYCHOTHERAPY IN A ‘SPECIAL’ HOSPITAL

In this paper, I describe and discuss the complexities of being a therapist in a maximum security forensic psychiatric hospital, working with patients who have committed acts of serious violence, and who also suffer from severe mental illness and personality disorders. I suggest that profound disturbances in the patient's inner world get played out in triangular disputes between the patient, the therapist and other professionals working in the hospital. I also describe how real events in the life of the institution impact on the therapeutic process, and the importance for the therapist of reflection on the ‘other 23 hours’ that the patient lives outside of therapy. Finally, I raise some ethical dilemmas that arise for therapists working in such settings, where the stated therapeutic aim is not only treatment but also the containment and prevention of future violence.     

中西医糖尿病分型分期对治疗学指导作用比较

糖尿病已成为一种严重威胁公众健康的疾病，其发病率、病死率和致残率均高。本文通过比较中西医学糖尿病的分型分期对治疗学的指导作用，探讨中西医结合更好地防治糖尿病的可行性。中医强调整体观念和针对个体的辩证论治。而西医强调群体化治疗并能迅速改善代谢紊乱，中西医结合发挥各自的优势可以有效地进行糖尿病及其并发症的治疗。     

TIME FOR LOVE: The Place of Marriage and Children in the Thought of Stanley Hauerwas

In essays written throughout his career, Stanley Hauerwas has unfolded a Christian vision of the marriage bond and the presence of children that seeks insistently to place these seemingly natural bonds within the new family of God that is the church. I examine his understanding, aiming to appreciate the Christian vision displayed while also suggesting that his emphasis on the new thing God does in the church is sometimes allowed to absorb and thereby lose the distinctive significance of the created bonds of marriage and family.     

Special Treatment? Flexibilities in the Politics of Regenerative Medicine’s Gatekeeping Regimes in the UK

ABSTRACT

Emerging flexibilities are apparent in gatekeeping regimes applicable to regenerative medicine products, raising issues about the extent to which and forms in which such flexibilities might promote emerging products as a sector warranting special treatment, in the context of recent policy developments in the UK and wider European Union. Concepts of ‘gatekeeping’, ‘gatekeeping regimes’ and ‘gateways’ can point to the ways in which regulatory institutions, health technology assessment organisations, and national planners and purchasers of health services together define and control entry to the medical product marketplace and the adoption of products into the public health-care system. Flexibilities in existing regimes and new gateways are a way of maintaining ‘connection’ between gatekeeping regimes and technoscientific innovation in order to steer innovation pathways. The gateways concept has affinity with that of Callon’s ‘obligatory passage points’. A wide set of recent policy documents show that the measures promoted exhibit a range of alternative gateways that are being constructed around central, legal, restrictive gatekeeping regimes. However, it would be easy to overestimate the significance of these developments as relaxations that would favour innovative producers and their products on a large scale with wide public health impacts. The concepts of gatekeeping regimes and gateways enable understanding of hybrid developments of exceptions and exemptions to dominant regimes which bridge across the arenas of market regulation, health technology assessment and health-care system planning. These arenas are being drawn closer together as a means of politically managing stakeholders’ aims in the UK, EU and other innovating biomedical health systems globally.