关于麻醉后监测治疗室的伦理思考

麻醉后监测治疗室(post-anesthesia care unit,PACU)中医学高新技术设备对确保手术后患者的安全发挥极其重大的作用,然而PACU中也产生许多危机与伦理冲突。为了PACU的良性发展,我们认为如下伦理准则必须遵循:科学认定准则、最佳选择准则、精益求精准则、无伤准则、患者自主准则。     

血液病治疗中的人文关怀

新医学模式指出人文关怀在医疗服务中有重要意义。目前我们在血液病治疗中对人文关怀重视不够。由于大部分血液系统疾病起病隐匿,发病机制不清,病程长,并发症多,所以预后差,再加上治疗费用高,社会角色转变困难,很容易使患者产生焦虑、抵触、恐惧、多疑、抑郁等心理问题,并影响和谐医患关系的建立。人文关怀有助于缓解患者的心理问题,促进良好医患关系的建立,加速疾病的恢复,提高患者的生存质量。     

论医学模式转变对助产土在产程守护中角色转变的影响

伴随着医学模式的转变,助产士在产程守护中的角色由单一守护者的角色向全面、多重角色转变,助产士的工作内容与职责也相应发生变化。现代医学模式下助产士的角色转变对医疗效果有良好的改进,体现了“以人为本”的医疗文化理念,同时也对助产士的要求更为全面。     

Depressive Symptoms Among Delinquent Youth: Testing Models of Association with Stress and Support

The high prevalence of depression among incarcerated youth indicates a need to better understand factors that contribute to depression within this vulnerable subgroup. Previous research in general community samples has suggested that high levels of stress and low levels of parental support are associated with depression in young people, but it is unclear whether or how they might be associated with depression among incarcerated youth who are already vulnerable. Using a sample of 228 adolescents (aged 13–18 years) who were detained in the juvenile justice system, stress and support were modeled as independent main effects and as interactive risk factors in relation to depressive symptoms. More stressful life events and less caregiver support were each independently associated with depressive symptoms, but no evidence was found for the buffering hypothesis in this sample. Stressful life events were more strongly associated with depressive symptoms among boys compared to girls.     

An Exercise in Psychological Growth*

The author presents a case report followed by a self- assessment exercise which was generated spontaneously in collaboration with the patient herself during the treatment process. The lists of questions, designed to provoke thought and stimulate maturation, were found to be quite helpful especially in making important life decisions. It is proposed as a learning tool and template for use by those confronting similar issues. Lois Gerby, MA, is a psychologist and family therapist in private practice, 32 Hapalmach St., Suite 32/7, Jerusalem, Israel 92542 (jack.friedman@mail.mcgill.ca). *Translation by Yacov Friedman and Haim Sherrf.     

Not without hope: a Reformed analysis of sickness and sin.

A Reformed understanding of sickness requires that connections be drawn between the structural effects of sin and the ways that sickness is experienced in people's lives. Such an understanding can be an important resource for the bioethicist, both the bioethicist who speaks from the Reformed tradition and the bioethicist who speaks to patients and caregivers who may assume that sin and sickness are connected, but may understand that linkage in overly simplistic ways.     

Primary care counsellors’ experiences of working with treatment resistant depression: A qualitative pilot study

Treatment resistant depression (TRD) is a severe and enduring form of depression that does not respond fully to medication. Although the evidence base for effective psychological treatments is not yet established, it is inevitable that counsellors working in primary care will encounter patients with this presentation. This pilot study explores the experience of four primary care counsellors with this patient group using Interpretative Phenomenological Analysis (IPA) and considers the implications for training and practice.     

Kinship Foster Care from the Perspective of Quality of Life: Research on the Satisfaction of the Stakeholders

A quality of life studies perspective has guided the design and implementation of research on kinship care as a placement resource within the child protection system in Catalonia (Spain). This research was carried out gathering the points of view of the three main stakeholders: kinship caregivers, children who are placed in extended family and practitioners of the EAIAs (Childhood and Adolescence Interdisciplinary Care Teams). Satisfaction involved in kinship care has been explored. In this article the main stakeholders’ satisfaction with kinship care is presented, and on the other hand, children’s satisfaction with life as a whole and with five specific domains in life is analysed: Education received from their caregiver, their school, their friends, their time enjoyment and their health. As expected, practitioners show the lowest evaluations with this kind of service. Surprisingly, evaluations by children referred to kinship care and to education received by caregivers are higher than those in the normative population aged 12–16 in relation to their own natural family. The findings show implications for practice and they imply challenges for quality-of-life research.