内科急症腹痛诊断的临床思维误区

急症腹痛是内科急诊患者最常见的主诉之一,具有发病急、变化快、病因复杂隐匿等特点,临床上极易误诊。本文从急症腹痛诊断思维活动的主观性、局限性、静止和片面性以及思维活动的教条性、惰性等角度深入探讨了急症腹痛误诊的常见临床思维误区。     

Games in Clinical Genetic Counseling Supervision

Games are defined as ongoing series of complementary ulterior transactions that are superficially plausible but have a concealed motivation to maximize pay-offs and minimize penalties for the initiator. While some games are harmless and part of socialization, others are destructive. Destructive game-playing in clinical supervision, in which game-playing (initiated by either supervisors or students) interferes with a student's realization of internship goals, has been documented in some allied healthcare professions but has not yet been studied in genetic counseling. Genetic counselors and clinical supervisors of genetic counseling students were anonymously surveyed regarding their experiences with destructive game-playing. Results show that such games do occur in genetic counseling clinical supervision. Some games are the same or similar to ones previously described in other health-care professions; others may be unique to genetic counseling. The purpose of this paper is to document these games as a first step to facilitating dialogue, understanding and awareness of them.     

口腔专业适宜技术与诊疗最优化

推行适宜技术和诊疗最优化的原则是避免过度医疗的有效途径。而在口腔专业中必须要体现其特殊性。口腔治疗的总体目标是健康、美观,这一目标有赖于患者的主观评价;患者在治疗中具有自主选择的权利,而医生提供专业上的支持和具体的执行。因此口腔科适宜技术的基本要求是:适合患者的自身条件和需求、符合医学专业诊疗原则的要求以及适合医生的个人技术水平。然而对于我国现阶段而言,适宜技术是一个宽泛且较低的标准,而口腔临床工作中应该以最优化的治疗作为实际追求的目标。     

腰椎疾病病因、诊疗方法的研究

腰椎疾病近年来发病率呈上升趋势,以退行性疾病、腰椎间盘突出和骨折创伤为主要类型。从疾病起源、发展、转归的角度,结合自然辩证法的理论,针对腰椎疾病的病因、诊断标准、治疗方法及效果三个方面进行了阐述和展望。对哲学应用于临床实践和科研教学等方面的基本问题,如对疾病发展规律的研究,诊断理论的建构等,进行了论述。     

人格研究中的行为遗传学取向的发展

人格的行为遗传学研究,是以研究遗传和环境的差异来解释人格的个体差异的程度为目的,为探讨遗传和环境在个体发展中的作用提供了新的研究途径。该文以天性和教养为突破口,紧紧围绕行为遗传学在人格研究领域的发展脉络:遗传力、环境、特定基因的研究,进一步探讨在个体人格发展过程中遗传和环境的交互作用的关系。     

Development of an Interactive Decision Aid for Female BRCA1/BRCA2 Carriers

Shared decision making between patients and providers is becoming increasingly common, particularly when there is no clear preferred course of action. As a result, decision aids are being adopted with growing frequency and have been applied to many medical decision-making issues. One such issue where there is uncertainty is breast cancer risk management among BRCA1/BRCA2 carriers. We present the development of a CD-ROM decision aid to facilitate risk management decision making in this population. Our decision aid was developed with the intention of providing it through a randomized clinical trial. The CD-ROM is a multimedia, interactive intervention which provides information about breast cancer, risks associated with BRCA1 and BRCA2 mutations, risk management options for hereditary breast cancer, and a breast cancer risk management decision aid. The goal of this CD-ROM, offered as an adjunctive intervention, is to reduce decisional conflict and psychological distress and improve comprehension of risk information, decisional satisfaction, medical adherence, and quality of life for this population of women at increased risk for breast cancer.     

What Predicts the Use of Genetic Counseling Services After the Birth of a Child with Down Syndrome?

In the state of Victoria, Australia, a government funded genetic counseling service exists to meet the needs of families. An audit showed that many families do not use this service after the birth of a child with a genetic problem. To investigate this we surveyed families of children born with Down syndrome over 2 years in Victoria. Questionnaires were completed by 74 mothers, of whom only 18 had received genetic counseling between the birth and the time of the study (mean 3.5 years). Of those not receiving genetic counseling, 71% said they were not offered or had not heard of it. Mothers who had genetic counseling were younger than those who had not, and were more likely to have attended University. Those who had genetic counseling indicated less satisfaction with care at the diagnosis and were more likely to perceive their child as unwell at birth than those who were aware of genetic counseling but did not have it. Of those who did not have genetic counseling, over half were unclear about what it is, although 74% agreed with the statement genetic counseling is most useful when planning to have another child. Of those who had heard of genetic counseling, 73% said they were not sure how it could help. Many families with children with Down syndrome are not aware of the existence or functions of genetic counseling. With greater awareness, some may still choose not to have genetic counseling, but others enunciated needs that could be met by this service if it were offered to them.     

Correlation between general factors for personality and cognitive skills in the National Merit twin sample

General factors of personality (based on the California Psychological Inventory) and cognitive skill (the National Merit Scholarship Qualifying Test selection score) were correlated .284 in a sample of 490 monozygotic and 317 dizygotic twin pairs. The correlation was partitioned into genetic, and shared and unshared environmental sources: approximately 39%, 50% and 11%, respectively. The results offered some support to a theory that such a correlation may reflect evolutionary trends, although questions remained about the role of nonadditive genetic variance and the nature of the selection involved.     

凋谢的大脑——烟雾病诊治中几个问题的思考

烟雾病在我国的报道逐渐增加,其致残率高,预后差,严重影响患者的生命和健康。本文结合今年来的有关研究文献,就烟雾病的命名、形成机制、诊断及治疗等方面的研究做一综合性的介绍。     

高频超声对膝关节病变的观察

通过超声对髌上囊、股骨髁间软骨情况、胭窝滑囊、髌腱等膝部结构的观察,评价超声对膝关节病变的辅助诊断、观察疗效的价值。通过高频超声对膝关节肿胀、疼痛病例纽与对照组、病例组治疗前后髌上囊液体、滑膜、股骨髁间软骨、胭窝滑囊积液情况以及髌腱厚度及回声进行对比观察。病例组髌上囊液体及滑膜增厚,股骨髁间软骨多有不同程度改变,胭窝滑...