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。     

The prevention of depressive symptoms in rural Australian women

Two interventions aimed at preventing depressive symptoms in women living in Western Australian rural communities were evaluated against a no‐intervention control condition. The standard intervention was based upon traditional cognitive‐behaviour treatments for depression; the experimental intervention was based upon prevention strategies derived from the learned helplessness model of depression (e.g. Peterson, Maier, & Seligman, 1993 ). Seventy‐six women were randomly assigned to either the standard or the experimental group, and a further 20 women formed a no‐intervention control group. The standard group showed a reduction in depressive symptoms at post‐test, but no effects at 6‐week or 6‐month follow‐ups. In contrast, a reduction in depressive symptoms did not appear for the experimental group until the 6‐week follow‐up at which time a less depressive attributional style was also evident; these effects were even more pronounced at the 6‐month follow‐up. The no‐intervention control group showed no changes across time. It is argued that these results support the applicability of prevention strategies based on the learned helplessness model to this population. Copyright © 2003 John Wiley & Sons, Ltd.     

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。     

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。     

农村初中生学习适应性发展的研究

本研究运用测量的方法考察了 3 86名农村初中生学习适应性的发展。结果表明 ,初一学生的学习适应性显著地好于初二、初三、初四的学生 ;男女学生的学习适应性差异显著 ;在“学习态度”、“学习技术”、“学习环境”、“身心健康”四个分测验中 ,年级差异非常显著 ;优等生和差生在学习适应性上也存在着非常显著的差异。     

Attention-Deficit Hyperactivity Disorder: The Medicalization of Misbehavior

During the past decade, there has been an increase in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, typically diagnosed in childhood, is characterized by inattention, hyperactive motor behavior, and distractibility. Current prevalence rates obtained in various countries generally exceed the 3–5% reported by DSM-IV. Reasons for increased ADHD prevalence include changes in diagnostic standards, overlap between ADHD and other externalizing disorders, nonspecific behavioral criteria, and the rapid effects of stimulant medication on cognitive functioning. However, social, cultural, and economic factors may also contribute to increased diagnosis. ADHD has become a common topic in the lay media. Popular discussions of ADHD may serve as a metaphoric expression of social anxieties, particularly with respect to children. At the same time, ADHD has rapidly become incorporated into a medical model, with emphasis on pharmacological treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicalization of behavioral problems. Collaboration between psychologists and primary care physicians can lead to more accurate diagnosis and appropriate treatment of ADHD and related disorders.     

Medical semiotics in the 18th century: A theory of practice?

Medical semiotics in the 18th century was more than a premodern form of diagnosis. Its structure allowed for the combination of empirically proven rules of instruction with the theoretical knowledge of the new sciences, employing the relation between the sign and the signified.     

Prescriptions: Autonomy,Humanism and the Purpose of Health Technology

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems.