The ‘Medical Body’ As Philosophy's Arena

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: (i) as a salutary reminder of the extent to which thereality even of the human body is constructed; and (ii) as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy's traditional (and traditionally abstract) questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the body familiar in daily experience. Toulmin's epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate.     

循证医学的辩证思维

随着临床医学的发展,临床医生面临着从理论知识加个人经验的医学模式向以科学证据为基础的医学模式转变。越来越多的卫生政策和诊疗指南的制定需要以高质量的研究结果为依据,如随机对照研究的结果,特别是随机对照研究的系统综述结论。循证医学模式要求医生在临床工作中不断提出问题并通过严格的科研设计来回答这些问题,同时强调不断进行知识更新,掌握最新研究证据以指导其临床工作。同时政府部门也鼓励发展循证医疗,因为它可通过研究有效的诊疗手段来提高卫生保健的效率。此外还有迹象表明法律决策过程中要参考是否遵循了研究证据和临床指南。知情的服务对象也促使临床工作者寻求研究证据作为依据,为了提高服务质量并且充分把握特殊专业领域的现状,临床工作者也需要不断了解新的依据信息。在众多的研究信息中,我们应对每项证据的研究方法、研究对象及观察的终点进行认真分析,确定该结论是否真实并适合我们的实际,从而制定有据可查的诊疗方案。     

An event in medical life,or the advent of a belief?

Freud's ambivalent relations with medicine are well known. Based on his relatively unknown text, A religious experience, published in 1928, the authors present an analysis of the internal reasons for this conflict. Responding to a letter from an American doctor, who tells him about his reactions to an autopsy and the influence it had on his religious faith, Freud suggests an analysis that leads him to make a surprising slip. This slip reveals the conflicts inherent in the practice of autopsy, considered as a peculiar event in medical training that puts a strain on the future medical practitioner's subjectivity. Based on the analysis of unconscious impulses and fantasmatic activity, the authors demonstrate that Freud's theory is still surprisingly relevant today in the light of testimonies from contemporary doctors confronted with autopsy during their training or daily practice.     

Polish students’ attitudes towards sexuality

The following article contains an analysis of medicine and pedagogy students’ attitudes towards sexuality. These attitudes were studied with the use of a scale of author’s own construction. The scale was used to determine: (1) the nature of respondents’ attitudes towards individual aspects of sexuality including several criteria: quality of life, health, acceptability, and morality; and (2) respondents’ preferences of normative regulations of sexual behaviours. It was found that the respondents accept love as relatively the most important aspect for the quality of life, and sex education (seen as a moral aspect). Students also give positive scores to physical aspects of sexuality, yet the scores are lower. Natural contraception in all its aspects is evaluated positively, whereas artificial contraception is evaluated ambiguously, similarly to masturbation and homosexuality. The fundamental norm in regulating sexual behaviour is the welfare of other human beings, the least important are the teachings of the Church.     

Publishing in Journals Outside the Box: Attaining Mainstream Prominence Requires Demonstrations of Mainstream Relevance

Primary pediatric medical care is as mainstream as any major cultural practice in the USA. Thus, publishing behavior analytic papers that pertain to problems that present in pediatric settings in pediatric medical journals is one route to mainstream relevance. With sufficient numbers of such papers, it could even lead to prominence. This article describes examples of publishing in pediatric journals and some lessons I learned from the experience. For example, (1) all child behavior problems that present in pediatric settings are of social importance but most are high-frequency, low-intensity problems that are not necessarily exotic or representative of serious pathology, and they usually respond to straightforward behavioral applications; (2) it is usually best to use a “colloquialized version of learning theory” when writing for and speaking to pediatric providers (and the families for whom they provide care); (3) pediatricians often have limited knowledge about behavior analytic research designs; and (4) when submissions are rejected by pediatric journals, the rejection can be exploited as an opportunity to educate pediatric editors and reviewers.     

高压氧医学与康复医学的协同发展

随着医学理论与实践的不断创新和发展,中国也正在努力寻求一种具有中国特色的现代医学发展模式.高压氧医学与康复医学都是新兴的边缘交叉性学科,具有广阔的发展潜能和空间;然而,两者在快速发展的同时也突显了一些问题,如：后续动力不足、发展方向不明确等.本文从哲学中联系与发展的角度出发,通过机制探讨及发展趋势的分析,试图寻找两者共同发展的结合点,为推动康复医学与高压氧医学在临床工作中的继续向前发展提供一种借鉴与参考.     

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。     

培养临床医学专业学位研究生系统思维能力的途径和方法

系统思维是20世纪中期以后发展起来的一种新型思维,它与传统还原论思维根本不同,强调立足于事物整体来认识和处理问题,注重揭示事物内部机制以及环境对整体的作用和影响。我国临床医学专业学位研究生的培养应该纳入这种现代思维方式,使其善于应用系统思维来指导诊断和治疗,并应用在医学科研中。这不仅有利于提高其服务广大患者的能力,而且有利于提高其临床医学科研能力,从而提高临床研究生的整体素质。     

Psychological Consequences of Pregnancy Loss and Infant Death in a Sample of Bereaved Parents

This study aimed to explore a broad range of psychological reactions to trauma in a sample of bereaved parents in order to assess whether the traumatic framework is adequate for describing the entire range of emotional reactions to infant death. A sample of bereaved parents (N = 455) who lost their child through perinatal or postnatal loss were compared to a control group of parents (N = 110) who gave birth to a healthy child. Multivariate regression analysis clearly demonstrated that bereaved parents scored significantly higher on the Depression, Anxiety, Dissociation, Sleep Disturbances, Somatization, Interpersonal Sensitivity, and Aggression subscales of the Trauma Symptom Checklist. Consistent with previous studies, the results showed that for up to 5 years postloss bereaved parents expressed elevated levels of trauma-specific and psychological outcomes, in particular interpersonal sensitivity and aggression.