如何成为一名优秀的骨科医生

目前,由于医疗模式的转变,除了对患者本身疾病的治疗外,患者的满意程度和生命质量也成为衡量治愈率高低的一个标准。因此,加强医护人员培养教育,提升医疗服务质量任重而道远。这篇文章探讨了成为一名优秀的临床医护人员所应具备的品质和能力特征。     

癌症患者临床决策倾向性的研究

为了解癌症患者对医生、自己和家属意见的临床决策倾向性,采取问卷调查和半结构访谈相结合的方法,调查120例住院癌症患者的临床决策倾向性。结果显示,(1)生活习惯相关决策,实际和理想的患者自己倾向性构成比值最高,为40%和33%;求医行为方面家属最高,实际和理想均为50%;常规检查、总体治疗方案、手术、化疗和放疗相关决策方面均为医生最高,分别为100%、90%、100%、90%和100%;(2)癌症患者理想和实际的临床决策倾向性构成比值均无差异(P0.05),但访谈显示29.17%的患者认为目前决策状态不理想。提示:(1)癌症患者在不同方面的临床决策倾向性有所不同。(2)癌症患者对临床决策状态基本满意,但有患者希望医生参与沟通更多或自己参与更多。     

The Concerned Mental Health Practitioner

Summary

A discussion is provided regarding a fundamental principle of psychology, a concern for other's welfare, as set out in the American Psychological Association's (2002) Ethical Principles of Psychologists and Code of Conduct. Although the principle concern for others' welfare is essentially aspirational in nature, this is an ethical principle that is at the core of the mental health professions' stated values, and that must be positively put into operation in a variety of professional contexts. Unlike so much else in professional ethics codes that involves injunctions of what not to do, or which attempts to limit the self-serving tendencies of professionals, this general principle is essentially positive, pointing to the need to approach others and to consider their welfare first.     

PATIENT‐ANALYST “WITHNESS”: ON ANALYTIC “PRESENCING,” PASSION,AND COMPASSION IN STATES OF BREAKDOWN,DESPAIR, AND DEADNESS

This paper focuses on the analyst's “presencing” (being there) within the patient's experiential world and within the grip of the psychoanalytic process, and the ensuing deep patient–analyst interconnectedness, as a fundamental dimension of analytic work. It engenders new possibilities for extending the reach of psychoanalytic treatment to more disturbed patients. Here patient and analyst forge an emergent new entity of interconnectedness or “withness” that goes beyond the confines of their separate subjectivities and the simple summation of the two. Using a detailed clinical illustration of a difficult analysis with a severely fetishistic‐masochistic patient, the author describes the kind of knowledge, experience, and powerful effects that come into being when the analyst interconnects psychically with the patient in living through the process, and that relate specifically to the analyst's compassion.     

The Life Skills Development Program

In 1974the Occupational Therapy Section at Dwight Eisenhower Army Medical Center established a Life Skills Development Program for the treatment of the hospitalized acutely ill psychiatric patient. The program used a process which moved the patient through specifically prescribed tasks designed to initiate the development of adaptive behavior. Three basic group areas were formulated. These were values clarification, competency training, and information class. Values clarification was designed as an introductory phase of treatment and was important in building initial rapport and implementing patient involvement. Through carefully selected tasks, the patient was relieved of the burden of initiating the group process and was quickly involved in the discussion of life-related topics leading to the establishment of his own priorities. Competency training included a wide range of material allowing the therapist to teach and the patient to practice skills related to work, socialization, use of free time, and self-maintenace. These groups were experiential in nature, encouraging the patient to practice adaptive behaviors in role play settings in the hospital as well as in the surrounding community. Information class was scheduled whenever facts were needed to increase clarity and to facilitate selection of alternative and adaptive behavior. Guest lecturing, "experts" were invited to speak to the group. Also, information based on authoritative sources was prepared and presented by the therapist. The program concept and specifically prepared life skills development material was shared with Army Occupational Therapists. The Life Skills Development Program was presented as an evolving treatment approach in Army Occupational Therapy at the 1975 AOTA Conference in Milwaukee, WI. This treatment approach has continued in Army Occupational Therapy since its introduction. Until recently no collective information was available about programs. A survey of questionnaire was conducted in June 1981 of all Army Occupational Clinics. The results of this survey indicated that not only was the Life Skills Development Program still in use in Army Hospitals, but its application and target population has expanded to become broader than initially proposed. The intent of this paper is to retrace the thought and steps leading to the introduction of the Life Skills Development Program, to describe the structure and rationale of its organization and to report on its current use in Army Occupational Therapy.     

论病历资料的法律价值

从法律价值角度,探讨病历资料具有的外在价值、内在价值及法治价值,病历资料作为证据法中的书证,能够证明客观事实的内在品质和其外在的证明作用、法治功能,在司法证明活动和处理医疗纠纷中发挥着重要作用,旨在提高人们对病历资料证据的认识,规范病历资料的书写、归档、保存和利用,促进司法证明和医疗服务质量的提高。     

实施临床路径管理 构建和谐医患关系

医患和谐是医患双方的共同需要,通过时单病种乳腺癌改良根治术等10个单病种临床路径与成本控制绩效分析,评价患者的满意效果。收集整理2006年7月至2007年12月10个单病种的统计信息,以其手术并发症发生率、平均住院天数、平均住院费用、患者满意率等作为评价指标,将实验组（应用临床路径和成本控制组）和对照组（未应用临床路径和成本控制组）进行对比分析。结果显示,应用临床路径和成本控制的患者与未应用这一方式的患者之间在手术并发症发生率、平均住院时间、平均住院费用、患者满意率方面有统计学显著差异。提示单病种临床路径和成本控制模式应用于临床管理,可以明显促进CQI（Continuous Quality Improvement持续性质量改进）,缩短平均住院时间,降低住院费用,提高患者满意率,并从根本上改善医患关系。     

从医疗活动的特点谈医患法律关系

医疗活动具有独特的特点,这就决定了医患双方会形成独特的法律关系.在诊疗康复关系和强制性的预防保健关系中,医患双方不能以合同关系论处,而在自愿性预防保健关系和特殊服务关系中,双方却只能用合同来调整.     

谈医疗行为中患者知情同意权的实现

目前,关于患者的知情同意权的讨论引起了众多医院管理者的关注。对知情同意与医疗行为的矛盾冲突进行探讨,提出医疗行为为中实现患者知情同意的对策及伦理原则。     

Incorporating Imagery Into Thought Records: Increasing Engagement in Balanced Thoughts

Thought records are one of the most effective CBT interventions. However, clients can find them overly intellectual. While clients may logically understand that their balanced thought is accurate, they may not be emotionally convinced, thus reducing the thought record’s effectiveness. In the present paper we describe how imagery can be used throughout the thought record process to enhance clients’ emotional engagement. We describe how imagery can be used to identify negative automatic thoughts, to increase the believability of evidence against negative automatic thoughts, and to increase emotional engagement with balanced thoughts.