论医疗卫生保健服务体系的合理结构——兼评医疗联合体

公共卫生、医院和初级卫生保健的三重结构,是当代医疗卫生服务系统结构的合理选择。三重服务体系相互配合,各司其职,为广大公众提供疫情管控、患病人群的诊治、居民健康管理与健康促进全方位的服务;初级卫生保健和其他各方面一起,担负着从源头上控制慢性病的发生与发展,实现健康国家、健康城市、健康社区的重任,处于基础和核心地位,也是从根本上解决看病难和看病贵的关键。医联体必须从健康中国和医疗卫生服务体系基本部署的大局出发做根本性的调整,强化初级卫生保健的基础和核心地位,不仅重视提升初级卫生保健的医疗功能,更要重视健康促进和健康管理的功能,将医联体建设成为防治并重、预防优先的医疗卫生保健联合体。     

新型冠状病毒肺炎试验性治疗的伦理辩护

虽已开展瑞德西韦、抗疟药磷酸氯喹、血浆疗法等临床研究,但迄今无任何新型冠状病毒肺炎的特效疗法。为最大程度确保患者及时获得治疗的权利,可借鉴抗击埃博拉疫情经验,新型冠状病毒肺炎患者的试验性治疗可在伦理上得到辩护。应确保试验性治疗的科学性,包括前期安全性和有效性数据,不同治疗方案的优先次序及持续评估。也从透明性、公平分配、知情同意和评估风险受益等考虑其伦理性。可从利益冲突管理、严密监测、确保数据完整性和社会参与等方面监管试验性治疗。以期为未来突发传染病的疫情防控提供借鉴意义。     

医患共同决策的具象问题思考——以肺结节诊疗为例

随着健康体检观念的深入及低剂量CT的广泛开展,肺结节的检出率大大提高,而对于其诊断及治疗方案的选择则具有较多的争议,过度诊疗或重视不足都会对患者造成伤害,如何做到正确的诊治从而保证患者的权益,患者的参与及接受程度显得十分重要,医患共同决策(shared decision making,SDM)这一方式在肺结节诊疗过程中的作用不言而喻。通过相关案例初步探索SDM在肺结节诊疗过程中的应用及效果,从而为临床医生及肺结节患者在诊疗过程中提供一种新的思路,也期望这种模式能够得到医患双方的共同认可,减少临床决策中的医患冲突,取得更佳的治疗方案。     

"易"论医学之道

"易"作为中国古代便形成的通俗唯物主义哲学,在指导社会及科技发展过程中,始终发挥着极其重要的作用.而历代医学先贤,无不对"易"有着深刻的理解."不知易,不足为大医"之论也始终是历代医者所遵循的至理名言.的确如此,人类社会的发展,无不体现在"变"的过程之中,传统哲学"易"的形成及发展,不仅本身是变的展示,而且对变化之道进行了精确的阐述,而祖国医学的形成及发展正是在这种理论的指导之下产生并逐步发展完善的.因而,"易"对传统医学而言,是根,是本,是原动力.     

The Influence of Race and Income on Community Mothers’ Acceptance of Child Management Methods

The consideration of diverse family factors on parents’ acceptance of behavioral parent training (BPT) components aids in the development and delivery of culturally sensitive parenting programs. Perceptions of acceptability are particularly important to investigate among low-income and racial-minority families, as they are less likely to engage in nonadapted BPT programs. Therefore, the current study examines the synergistic effects of race and income on mothers’ acceptance of five common child management methods relevant to BPT. The relationship between mothers’ acceptability ratings and self-reported parenting practices was also explored. Participants were 106 White and Black mothers from different income levels who completed measures related to the acceptability of response cost, positive reinforcement, time-out, spanking, and medication. The results indicated that mothers from varying backgrounds differed in their acceptance of child management methods, particularly with regard to corporal punishment. Additionally, a relationship was found between parents’ acceptability ratings and their self-reported parenting behavior. The findings support the consideration of parents’ perceptions of child discipline methods when recommending and delivering BPT programs to diverse parents.     

Have Phobias,Will Travel: Addressing One Barrier to the Delivery of an Evidence-Based Treatment

Although a host of evidence-based treatments exist for youth with anxiety disorders, less than 30% of youth and their families receive these treatments. One of the main barriers to receiving these treatments is the lack of access to care, due largely to the absence of mental health professionals who have expertise in the delivery of these treatments in certain geographic locales. The current study examined whether a brief intensive treatment for specific phobias (SPs), Augmented One-Session Treatment (OST-A), would result in comparable treatment gains for families who traveled a considerable distance to receive this treatment when compared to families who resided in our local community. Participants included 76 youth with a clinically confirmed diagnosis of SP (38 local families and an age- and sex-matched sample of 38 nonlocal families). Although SP severity at pretreatment was significantly greater for the nonlocal youth than the local youth, both nonlocal and local youth showed commensurate improvement and maintenance of treatment gains over a 6-month period across several clinical outcome measures. Findings from this study show that OST-A is effective when families choose to travel for treatment, addressing at least one of the barriers to use of this evidence-based treatment.     

Prevalence and Predictors of Psychological Violence Against Male Victims in Intimate Relationships in Canada

Psychological violence involves expressive violence (i.e., the use of words to humiliate or psychologically harm a partner) and coercive violence (i.e., controlling behavior directed to dominate and manipulate a partner). From studies that collect data on both physical and psychological violence, it is apparent that psychological violence is the most prevalent form of intimate partner violence (IPV). However, psychological violence is one of the dimensions of IPV that has received relatively less attention. Furthermore, very little is known about the state of female-to-male psychological violence, as most studies on the subject have focused on female victims. This study seeks to understand recent trends and prevalence of psychological violence in male-to-female and female-to-male relationships in Canada. Using the 2014 General Social Survey (Victimization) data, the risk factors of female-to-male psychological violence were analyzed. The findings of the analysis revealed that there are significant differences in the prevalence of psychological violence among victims when gender is taken into consideration. The study also revealed that childhood victimization, childhood exposure to domestic violence, marijuana use, and educational attainment are predictors of female-to-male psychological violence. The study highlights the need for more studies to be conducted to attain a better understanding of the nature and context of psychological violence in heterosexual relationships.     

Patients’ expectations for the functional and psychosocial outcomes of orbital decompression surgery for thyroid eye disease: a qualitative study

Patients with appearance-altering conditions may be dissatisfied with the outcomes of reconstructive surgery due to unmet expectations. This study explored patients’ expectations of orbital decompression surgery for thyroid eye disease (TED) and whether these were met. Semi-structured interviews were conducted at two times: (1) in the weeks after patients were listed for decompression surgery and before surgery; (2) up to 12 months after surgery. Thematic analysis was performed for each time point, to identify themes within the data. Fourteen adults with TED were interviewed prior to surgery and five were followed up after surgery. Thematic analyses found: (1) Prior to surgery, patients had formed expectations through online information about the procedure, consultations with physicians, the impact TED had on their lives, and speaking to relevant others. Patients had specific expectations about the procedure, the recovery, post-operative appearance and post-operative vision. (2) After surgery, patients generally felt their appearance and well-being had improved. However, dissatisfaction was linked to unanticipated specific aspects of surgical care, recovery, or appearance. Dissatisfaction can arise from unmet expectations for the outcomes of reconstructive surgery. Physicians should be aware of the processes by which patients form expectations, for example different types and quality of online information. Ensuring that preoperative expectations are realistic could enhance satisfaction after surgery.