抑郁和焦虑与心血管疾病

抑郁焦虑与心血管疾病的关系最能体现身与心两者相互影响、不可分割的特点。但临床上,心血管疾病患者抑郁焦虑的诊疗率不足1％。这说明现有的诊疗理念和方式没有将心血管疾病和精神障碍联系起来,给患者全面全程的干预和管理。这样的缺陷不仅增加患者的痛苦和功能障碍,也增加心血管疾病的发病率和病死率,还增加患者及社会的医疗负担。本文结合临床经验,从心身一体的诊疗理念,谈谈抑郁焦虑与心血管疾病。     

论卓越医生教育与医学精英教育的关系

卓越医生教育培养计划是国家为提高医学教育质量采取的一项重要举措。卓越医生教育是否是医学精英教育,是否需要精英教育,这是医学教育工作者从理论和实践上需要面对和解决的问题。从卓越医生教育与精英教育的释义入手,对两者的培养目标、培养模式、培养数量、教学方式与方法、教学资源配置、管理体制等方面的异同点进行了比较分析,指出卓越医生教育要结合实际,遵循规律,吸取医学精英教育的精华。这对正确实施卓越医生培养计划,促进医学教育改革具有重要的现实意义。     

历史的沉思：医学伦理学与生命伦理学学科特点及定位

对医学伦理学与生命伦理学学科的特点及定位进行再认识,是推动两个学科发展的理性前提。再认识需要历史视野,即将其置于该学科发展尤其是生成该学科的实践资源演变的历史长河中加以动态考察。研究表明,医学伦理学具有在传承中追求完善的职业实践性系列特点,定位为医学与伦理学交叉学科不存异议,将其称为人文医学学科具有创新价值,但需充分论证;生命伦理学虽同医学伦理学联系密切且有所重叠,但却具有追踪生命科学发展前沿的专业实践性系列特点,因而可将其定位为生命科学、伦理学、医学伦理学等相互交叉的新学科。     

三维度立体叙事医学教育课程体系的实践与思考

梳理叙事医学的起源与在国内外的发展,剖析南方医科大学2016级50名临床本科生叙事医学教育现状,基于叙事医学在医学生中的知晓率偏低,接受度仍有待提高,以及医学生在接受专业教育的同时希望获取人文教育的结果,在"珠医博雅苑"叙事医学教育平台上打造"理论储备夯实基础、自主体验强化理解、临床实践融会贯通"的三维度立体叙事医学教育课程体系,获得了良好的教学效果,为叙事医学教育作为有效的临床实践工具提供了思路和借鉴。     

"人文解剖学"视野中的医学创伤与医疗干预

医学发展至今,一直是"征服疾病"的干预手段,这种干预有着扩展和泛化的趋势,逐渐由修复向替代发展.随着医学人文思想的逐步觉醒,"人文解剖学"的引入,人们开始对医疗干预,尤其是创伤干预进行了反思.微创医学的兴起,从三个方面给予这种过度干预以新的思考.由此而得到的启示是,医学需要两盏灯引路,一盏是职业和技术的灯,一盏是人文主义的灯.     

医学与艺术:临床医学和医学人文学关系探索

医学与艺术是医学人文学研究的重要课题.医学与艺术有着广泛的联系,涉及对临床医学性质的争论,医学人文学对临床医学教育与实践的作用,艺术对医学的表现与理解,以及作为治疗康复手段的艺术.     

Are psychodynamic and psychoanalytic therapies effective?: A review of empirical data

There is a need for empirical outcome research in psychodynamic and psychoanalytic therapy. However, both the approach of empirically supported therapies (EST) and the procedures of evidence‐based medicine (EBM) have severe limitations making randomised controlled trials (RCTs) an absolute standard. After a critical discussion of this approach, the author reviews the empirical evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. The review aims to identify for which psychiatric disorders RCTs of specific models of psychodynamic psychotherapy are available and for which they are lacking, thus providing a basis for planning further research. In addition, results of process research of psychodynamic psychotherapy are presented. As the methodology of RCTs is not appropriate for psychoanalytic therapy, effectiveness studies of psychoanalytic therapy are reviewed as well. Studies of psychodynamic psychotherapy published between 1960 and 2004 were identifed by a computerised search using Medline, PsycINFO and Current Contents. In addition, textbooks and journal articles were used. Twenty‐two RCTs were identifed of which 64% had not been included in the 1998 report by Chambless and Hollon. According to the results, for the following psychiatric disorders at least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identifed: depressive disorders (4 RCTs), anxiety disorders (1 RCT), post‐traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance‐related disorders (4 RCTs). According to results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi‐experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research.     

人文社会医学教育应纳为继续医学教育的重要内容

从人文社会医学的概念、现状及加强人文社会医学继续教育的重要性,阐述了应将人文社会医学教育纳为继续医学教育的重要内容的现点.指出加强人文社会医学继续教育应统一认识,加强领导;强化培训,纳入正规;注重实践,回归社会.     

肢体延长与美容增高的启示

美容医学持续升温,“美容增高”即“肢体延长术”被越来越多的爱美男女所尝试。纵观其发展经历了许多挫折与失败,并发症多且严重,应慎重认识其实际效果。如不加选择地运用美容医学,是对医学核心价值体系的扭曲和嘲弄。只有坚持运用正确的哲学思维进行引导,肢体延长术才会健康发展。