中国养老机构治理地方立法现状——基于85部地方立法文本分析

对我国现行有效的85部涉及养老机构治理的地方立法进行文本统计分析,发现普遍存在相关法规可执行性不强、缺乏监管部门之间协同治理的法律规范、鲜见规范养老机构服务合同的条款、忽视机构评价标准和信用体系的重要性、医养结合相关法律规范亟需完善等问题。因此,应当加强地方立法可执行性、完善各部门协同治理策略、细化养老机构服务合同条款、重视机构评价标准和信用体系的重要性、健全医养结合养老地方立法规范,从制度层面切实有效地支持机构养老产业良性健康发展。

     

On the Domain of Metaphilosophy

This article argues for four interrelated claims: (i) Metaphilosophy is not one sub‐discipline of philosophy, nor is it restricted to questions of methodology. Rather, metaphilosophical inquiry encompasses the general background conditions of philosophical practice. (ii) These background conditions are of various sorts, not only those routinely considered “philosophical” but also those considered biographical, historical, and sociological. Accordingly, we should be wary of the customary distinction between what is proper (internal) and merely contingent (external) to philosophy. (iii) “What is philosophy?” is best understood as a practical question concerning how members of different philosophical sub‐communities identify what is pertinent to their respective activities and self‐conceptions. (iv) Given (i)–(iii), understanding what philosophy is requires us to take more seriously the social‐institutional dimension of contemporary philosophical practice.     

Infantile defences in parent‐infant psychotherapy: The example of gaze avoidance

Findings from parent‐infant observational research have stimulated the development of intersubjective models of psychotherapeutic action. These models have brought out the infant as an interactive partner with the parent. Conversely, interest in describing the individual psyche of the baby has decreased, especially the unconscious levels of his/her experiences and representations. In parallel, clinicians and researchers have been less prone to apply classical psychoanalytic concepts when describing the internal world of the infant. The author argues that this is inconsistent with the fact that psychoanalytic theory, from its inception, was founded on speculations of the infant's mind. He investigates one such concept from classical theory; the defence. Specifically, he investigates if selective gaze avoidance in young babies may be described as a defence or even a defence mechanism. The investigation links with Selma Fraiberg's discussion of the phenomenon and also with Freud's conception of defence. The author also compares his views on the baby as a subject with those suggested by infant researchers, for example, Stern and Beebe. The discussion is illustrated by vignettes from a psychoanalytic therapy with a 3 month‐old girl and her mother.     

医疗机构药品购销职务犯罪情况研究——以中国裁判文书网82份判决书为样本

为进一步认识我国医疗机构从业人员药品购销领域职务犯罪现状,采用案例分析法分析中国裁判文书网相关文书。研究发现,当前案件发生率较高、形势依旧复杂严峻,涉案金额高,社会危害性大,涉案主体相对集中,犯罪行为普遍具有较强的持续性和重复性,判决罪名以受贿罪为主,管理混乱与制度落实不到位是滋生犯罪的土壤。建议探索医药产品定价采购的科学机制,完善制度体系,建立管控机制,提高医疗机构从业人员薪资待遇,加强并创新廉洁教育,运用科技监督手段。     

Confidentiality, privacy, and the facilitating role of psychoanalytic organizations

Burgeoning external threats to confidentiality by claims to clinical information create unprecedented challenges for psychoanalysts. Internal threats arise from the use of clinical material for educational, scientific and historical purposes. Traditionally, confidentiality is considered a patient's right and an analyst's obligation; privacy is not usually stated as a professional requirement. Little consideration has been given to the impact of the confidentiality and privacy dilemmas that analysts encounter throughout their careers. There has been no systematic examination of the confidentiality policies of psychoanalytic organizations, nor has their role in facilitating maintenance of patient confidentiality and analysts' privacy been made explicit. The research reported here was undertaken to address these issues and to obtain baseline information about the current confidentiality policies and practices of psychoanalytic organizations in three English-speaking countries (Britain, Canada and the USA). The author discusses survey results in the light of the challenges which arise at each phase of the analytic career. She makes suggestions as to how psychoanalytic organizations can and should facilitate analysts' resolutions of contemporary confidentiality and privacy dilemmas.     

论制度、体制、机制对医院文化的影响

现代医疗发展过程中,相关制度、体制和机制的缺失,已经成为制约医院文化和医学人文精神发展的重要因素,也是医院管理者必须面对的现实课题。介绍了医院文化的三个层面,阐述了医院运营中处理好经济利益与社会责任之间关系的重要性,认为建立相对公平的社会秩序和科学合理的文化建设战略对医院文化建设意义重大。以徐州仁慈医院为例,介绍了其在文化建设和制度引导方面的理念和做法,最后指出只有完善制度,创新机制和体制,才是医院文化发展的有效路径。     

Religious support and psychosocial well-being among a religious Jewish population

The three subscales of the Religious Support Scale assess perceived support from a person’s religious community, religious leaders, and God. This three-factor structure was replicated in the current study with a sample of 277 religious Jewish persons residing in Israel. Hierarchical canonical analysis showed that, even after controlling for general social support, Religious Leader and God Support were related to lower emotional distress, Religious Leader and Religious Community Support contributed to a higher level of life satisfaction, and Religious Community and God Support contributed to the prediction of perceived health. Findings are discussed in terms of religious support’s generalizability as a psychosocial resource for persons of various faiths.     

Infant observation and the French model

Psychoanalytic training in the French Societies belonging to the International Psychoanalytic Association does not grant any place to the observation of babies as it exists in certain societies of other countries. Infant observation is even the object of sharp critiques by eminent French theoreticians. The reasons given for condemning infant observation and refusing to give it any place in the training programme lie in theoretical positions concerning the very nature of the Freudian discovery and its interpretation, which is more idealistic than empirical. The author discusses these reasons while drawing attention to the frequent confusion between a reference to empiricism and a reference to the experimental. The fear of a psychologizing deviation of metapsychology and of a denial of psychic reality leads, in the French model, to placing the emphasis on personal analytic experience during the candidate's psychoanalysis, prolonged by supervisions. It excludes any academic teaching of metapsychology or of related disciplines. The confusion between the empiricism of Esther Bick's method and the recourse to experimental procedures in developmental research stands in the way of making a place for infant observation and of recognizing its training value, not so much for the acquisition of new knowledge or the validation of metapsychological models, as for its usefulness in developing a mode of psychoanalytic observation and an increase in the candidates' containing capacities.     

The role of the patient's remembered history and unconscious past in the evolution of Betty Joseph's 'Here and now' clinical technique (1959-1989)

The author historicizes one aspect of Betty Joseph's ongoing technical contributions in terms of its originating London kleinian context. Early on she drew upon both the patient's remembered history and unconscious past, linking these experiences in past-to-present transference interpretations in order to effect psychic change. In evolving the technique of 'here and now' analysis, Joseph came to emphasize a communicative definition of projective and introjective identification as well as the significance of enactments while marginalizing the use of part-object anatomical interpretative language. She gradually set aside directly linking the patient's past with the present, compelled now by making direct contact with her patients. She now tracked how difficult patients acted in and responded to interpretations from moment to moment. The author maintains that the explicit and implicit conceptual work of Wilfred Bion as well as Joseph's continuous group workshop for analysts led to an increased understanding of the patient's projective impact on the analyst's countertransference responses, and thereby increased the analyst's capacity with 'difficult to treat' narcissistic spectrum patients described by her colleague, Herbert Rosenfeld. In recent work, while Joseph continues to elucidate what patients recall about their early past, she formats her understanding in terms of a direct analysis of the structure of the patient's projected internal object relations in the transference. The analyst works with the patient's communications and enactments, with a greater emphasis on a more 'inside-to-outside' understanding of transference in contrast to the earlier 'past-to-present' work associated with both Freud and Klein. This investigation concludes with one example of Betty Joseph's significant impact on contemporary kleinian technique by taking up some of Michael Feldman's work. Now the analyst listens to the 'past presented,' the patient's projected internal world, as well as tracks how the patient hears and subtly mishears interpretations for defensive, equilibrium-maintaining purposes, as the analyst attempts to effect psychic change by widening the ego's perceiving functions.     

Inside and outside the window: some fundamental elements in the theory of psychoanalytic technique

The underlying concern of this paper is that psychoanalysis as practised today is in danger of losing its specificity and so losing its way. The author suggests this is possible for three reasons: the problem analysts face in responding to the strong emotional demands the great majority of patients necessarily place on them, the unintended consequences of the apparent success of 'here and now technique' and the absence of good clinical theory. The paper mainly discusses the author's ideas about some core elements of the clinical theory that all psychoanalysts must use when they are working and proposes (at the risk of being facile) some relatively simple heuristics related to them which are meant to be helpful. Recalling Kurt Lewin's maxim that 'there is nothing so practical as a good theory', he will suggest that continuous reflection on how one is using theory in daily practice is highly practical, if the theory is good enough. Theory in fact is a necessary 'third' in psychoanalytic practice which, if kept in sufficient working order close enough to clinical experience, provides an ongoing and very necessary check on our sense of reality. But, of course, as a third it can, like reality itself, be the focus of both love and hate with equally problematic consequences. The paper starts with a clinical example of a difficult but apparently successful analysis reaching its end, which will be used throughout the paper to illustrate and elaborate the theoretical ideas set out.