"以病人为中心"医疗服务模式的理念与发展

纵观20世纪医疗服务的发展历程,医疗服务的发展经历了“以疾病为中心”的传统医疗服务模式到“以病人为中心”的新的医疗服务模式的转变;目前,以“以病人为中心”的医疗服务模式已经成为我国现代医院改革与发展的主题。因此,在阐述医疗服务模式变革与发展的基础上,系统论述了“以病人为中心”的医疗服务模式的内涵与特点,新的理念、新的认识,也带来了新的希望,新的医疗服务模式将不断地改善与提高人们的健康状况与生活质量。     

Dualism and its Importance for Medicine

Cartesian dualism has been viewed by medical theorists to be oneof the chief causes of a reductionist/mechanistic treatment ofthe patient. Although I aver that Cartesian dualism is one culprit for the misapprehension of the genuine treatment of patients in termsof both mind and body, I argue that interactive dualism whichstresses the interaction of mind and body is essential to treatpatients with dignity and compassion. Thus, adequate medical carethat is humanistic in nature is difficult (if not impossible)to achieve without physicians adhering to a dualistic frameworkin which the body and person is treated during illness.     

Managing one's body using self-management techniques: practicing autonomy

This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come to rely on measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy.     

Assessment of the Use and Feasibility of Video to Supplement the Genetic Counseling Process: A Cancer Genetic Counseling Perspective

Cancer genetic counselors use a variety of teaching modalities for patient education. This survey of cancer genetic counselors assessed their use of educational videos and their recommendations for content of future videos. Thirty percent of respondents use videos for patient education. Cited benefits included reinforcement of information for clients and increased counselor efficiency. Of the 70% who do not use videos, predominant barriers included the perceived lack of an appropriate video, lack of space and/or equipment, and concern that videos are impersonal. Most respondents desired a video that is representative of the genetic counseling session, but emphasized the importance of using broad information. Content considered critical included the pros and cons of genetic testing, associated psychosocial implications, and genetic discrimination. The results of this exploratory study provide data relevant for the development of a cancer genetics video for patient education, and suggestions are made based on aspects of information processing and communication theories.     

Differences in Individual Approaches: Communication in the Familial Breast Cancer Consultation and the Effect on Patient Outcomes

This multicenter study aimed to assess (i) whether individual clinical geneticists and genetic counselors vary in their communication skills and (ii) whether this variation in communication impacts on patient outcomes, such as anxiety, depression, genetics knowledge, and satisfaction. One hundred and fifty women from high-risk breast cancer families attending their first genetic counseling consultation completed pre and post-consultation self-report questionnaires. The consultations were audiotaped and transcribed verbatim. Univariate analyses showed highly significant differences between individual clinical geneticists and genetic counselors in: facilitating understanding (p 0.001); facilitating active involvement (p 0.001); facilitating partnership building (p = 0.003); addressing emotional concerns (p 0.001); and discussing prophylactic mastectomy (p = 0.017). Multivariate linear regressions showed that this variation in communication resulted in a greater change in patients depression 4 weeks after the counseling session (p = 0.017). These findings suggest clinical geneticists and genetic counselors have achieved some standardization in communicating information, but showed diversity in their facilitation skills. Communication skills may be a useful area to explore further in this field.     

Strategies of professional assistance after traumatic deaths: Empowerment or disempowerment?

Dyregrov, K. (2004). Strategies of professional assistance after traumatic deaths: Empowerment or disempowerment? Scandinavian Journal of Psychology, 45, 181–189. Referring to research and theory in the field, this discussion paper addresses the more overarching question of current strategies for professional assistance to populations bereaved by traumatic death. The issues and controversies that have long surrounded the “medicalization” of mental health arise anew with respect to the medicalization and professionalization of psychosocial help for people who have been traumatically bereaved. Who should provide what help and how? To what extent should the bereaved be expected to help themselves, receive help and support from friends and family, or even the wider community; and to what extent should the bereaved be able to access appropriate professional help when they are in crisis? Recent studies have indicated that bereaved parents want to receive help from mainstream crisis psychology, and this is not always available. Families experiencing traumatic bereavement are not able to access appropriate services along the same lines as those suffering similar levels of somatic complaints. It is argued that the main factors contributing to this situation are the lack of knowledge and inadequate organization of services; the fact that somatic issues take priority over psychosocial difficulties and dysfunction, and curative services over prophylactic intervention; and particularly the de‐medicalization ideology. By not listening to the needs of user groups, the de‐medicalization movement disempowers rather than empowers users – the very opposite of the desired effect.     

Using video modeling and reinforcement to teach perspective-taking skills to children with autism

We evaluated video modeling and reinforcement for teaching perspective-taking skills to 3 children with autism using a multiple baseline design. Video modeling and reinforcement were effective; however, only 2 children were able to pass an untrained task, indicating limited generalization. The findings suggest that video modeling may be an effective technology for teaching perspective taking if researchers can continue to develop strategies for enhancing the generalization of these new skills.     

A Practitioner's Perspective of Preventing Reading Difficulties in Young Children

In this paper, the report by the Committee on the Prevention of Reading Difficulties in Young Children is discussed from a practitioner's perspective. The many and notable strengths are described, including the comprehensive review of the topic, the balanced manner of the report's conclusions, and the way in which the report was written. The weaknesses of the report also are presented.     

Measuring Judgments of Professionals: Using Vignettes in a Social Survey About Patient Confusion

The use of a factorial survey to measure the clinical judgments of professionals is described. This design allows the researcher to partial out the effects of variables on clinical decision making while using probability sampling. Methods frequently used to study judgments are reviewed and a study of nurses' judgments about patients' confusional episodes are used to illustrate the application of the factorial survey. Acute confusion in patients is a common clinical problem for nurses working in medical-surgical units in acute care hospitals. Using the factorial survey to study a real-life problem such as confusion demonstrates how this design can be used to test judgments in complex clinical situations, to aid in concept development, and to identify consensus among professionals.     

未来取向应对的双阶段序列模型及其时间透视机制

最近的研究表明, 未来取向应对对于应激管理起着不可忽视的重要作用。但预先应对和预防应对的关系及其作用机制, 一直是困扰应对研究者的重要问题。我们的前期工作显示, 序列模型比平行模型能更好地表征预先应对和预防应对的内在关系, 时间透视比威胁知觉更能解释预防应对的前因。本项目首次以时间知觉和内隐态度为切入点, 探索未来取向应对机制的理论模型。研究内容拟包括：(1)以大学生就业为情境, 构建未来取向应对的双阶段序列模型; (2)以大学生入学适应为情境, 用内隐认知充实和验证未来取向应对的序列模型; (3)用时间折扣模型的任务范式, 探讨未来取向应对不同阶段的时间透视机制：(4)用威胁性和中性的阈下面孔作情绪启动, 验证未来取向应对不同阶段的时间透视机制。本研究为发掘预先应对和预防应对的关系及其内在机制, 及基于未来取向应对的干预在心理健康和教育领域的应用奠定了基础。