当今医学缺少的是什么--论医学中的人文

医学首先是一项社会事业,而后才是一门学科。医学的内在道德原则要求医学具备人文精神和人文内容。人文和科学技术是医学的两个必要的基本的组成部分。医学人文的缺少和流失使当今医学成了“半吊子”医学。为了纠正这种偏差,医学教育应该是人文精神和人文内容的教育优于技术的教育,而医学决策者和研究者在其中的责任最大。     

人文医学与医学人文学几个问题之我见

结合医疗实际工作人文医学和医学人文学的关系应包括：(1)从人文医学的产生背景看,人文精神的内涵孕育于中国古典医学,并非现代之专有;(2)人文医学和医学人文学并非同一层次上的概念,不能交叉理解和使用;(3)从医学发展阶段的划分,提出不能将人文医学与现代医学割裂开,前者是后者的组成部分;现代医学并非生物医学;(4)人文医学的分类应增加军事医学等内容。     

A BEHAVIORAL SYSTEM FOR ASSESSING AND TRAINING CARDIOPULMONARY RESUSCITATION SKILLS AMONG EMERGENCY MEDICAL TECHNICIANS

Many deaths from cardiopulmonary arrest can be prevented by the prompt and effective administration of cardiopulmonary resuscitation (CPR). In this study, we examined the standard training program for teaching CPR to emergency medical technicians (EMTs). We developed an alternative experimental program whereby the behaviors involved in CPR were assessed easily and in greater detail. This assessment provided the basis for a system in which effective CPR skills were reinforced and problems were corrected. Subjects who were trained in CPR according to this experimental program performed more effectively than subjects in the standard program. In addition, retention (maintenance) measures indicated that experimental subjects continued to perform well, often more effectively than professionally employed EMTs.     

Response restriction and substitution with autistic children.

Few studies to date have examined time reallocation in naturalistic, multiresponse human repertoires when one or more responses are restricted. For this experiment, free-operant baseline levels of six responses were measured for four autistic children. The high-probability responses were made unavailable, one at a time, such that subjects had access to five, four, three, and two responses in successive restriction conditions. A return to the six-response free-operant baseline condition completed the experiment. Results were compared to predictions made by four time-reallocation models. These results were described accurately only by the selective substitution model. Further analyses examined alternative explanations for the individual reallocation patterns obtained. An expanded selective substitution definition is proposed that may characterize orderly patterns observed in multiresponse repertoires under restriction conditions more accurately than the other existing models.     

Determinants of pausing under variable-ratio schedules: Reinforcer magnitude, ratio size, and schedule configuration

Pigeons pecked a key under two-component multiple variable-ratio schedules that offered 8-s or 2-s access to grain. Phase 1 assessed the effects of differences in reinforcer magnitude on postreinforcement pausing, as a function of ratio size. In Phase 2, postreinforcement pausing and the first five interresponse times in each ratio were measured as a function of differences in reinforcer magnitude under equal variable-ratio schedules consisting of different configurations of individual ratios. Rates were also calculated exclusive of postreinforcement pause times in both phases. The results from Phase 1 showed that as ratio size increased, the differences in pausing educed by unequal reinforcer magnitudes also increased. The results of Phase 2 showed that the effects of reinforcer magnitude on pausing and IRT durations were a function of schedule configuration. Under one configuration, in which the smallest ratio was a fixed-ratio 1, pauses were unaffected by magnitude but the first five interresponse times were affected. Under the other configuration, in which the smallest ratio was a fixed-ratio 7, pauses were affected by reinforcer magnitude but the first five interresponse times were not. The effect of each configuration seemed to be determined by the value of the smallest individual ratio. Rates calculated exclusive of postreinforcement pause times were, in general, directly related to reinforcer magnitude, and the relation was shown to be a function of schedule configuration.     

按键位置对手机键盘拇指操作绩效的影响

本研究假设对于同样的手机键盘操作任务,手机各按键的位置不同,在操作绩效上存在差异。该研究实验从被试的客观操作绩效(反应时和正确率)和主观满意度评价两方面证实了该假设的成立:在保持被试自然姿势操作手机键盘的情况下,各按键在手机键盘中的位置确实对操作工效有较大影响。     

时间变量对大学新生人格特质的影响

以台湾地区某大学新生,从1998至2003共六届3141人为对象,分析人格改变情形,统计结果发现13项人格特质的赖氏人格量表中达显著差异的有6项,包括社会外向、攻击性、变异性、神经质、自卑感及虚伪性。性别分析达显著差异的共7项,包括活动性、客观性、协调性、攻击性、变异性、自卑感及神经质;男学生显著高于女学生的有活动性及攻击性,女学生显著高于男学生的有客观性、协调性、变异性、自卑感及神经质。结果显示在时间变量中,大学新生的人格的确发生了转变。     

科学临床思维与临床决策

临床医学不仅是经验科学,更是思维和决策的科学,养成科学的临床思维方式是每位医生的首要目标。本文介绍科学临床思维的理论基础和训练方法,进一步阐述科学临床决策的实施步骤,以提高医生的临床思维能力,使其思维真实与病人的客观真实相统一,以便更好地为病人服务。     

Reasoning about artifacts at 24 months: the developing teleo-functional stance

From the age of 2.5, children use social information to rapidly form enduring function-based artifact categories. The present study asked whether even younger children likewise constrain their use of objects according to teleo-functional beliefs that artifacts are "for" particular purposes, or whether they use objects as means to any desired end. Twenty-four-month-old toddlers learned about two novel tools that were physically equivalent but perceptually distinct; one tool was assigned implicit function information through a short demonstration. At test, toddlers returned to the demonstrated tool when asked to repeat the task, but, unlike older children, also used it for another task. Results imply that at 24 months, toddlers expect artifacts to have functions and proficiently use a model's intentional use to inform tool choices, suggesting cognition that differs from that of tool-using monkeys. However, their artifact representations are not yet specified enough to support exclusive patterns of tool use.     

A Test of Three Alternative Hypotheses Regarding the Effects of Early Delinquency on Adolescent Psychosocial Functioning and Substance Involvement

This study compared alternative hypotheses (from general deviance, life course, and developmental psychopathology perspectives) regarding the effects of early adolescent delinquency on psychosocial functioning in family, school, and peer contexts, and on alcohol use. Analyses also examined parent-child negative affective quality, prosocial school orientation, and peer substance use as possible direct predictors of problem substance use. Participants in this longitudinal study, extending from age 11 to age 18, were 429 rural teens (222 girls) and their families. Path model comparisons supported the tenability of a partial mediation model that included mediating pathways and a direct effect of delinquency on alcohol use, as hypothesized by developmental psychopathology. A supplemental analysis controlling for the stability of the family, school, and peer variables revealed that delinquency had less pervasive direct effects on, and a nonsignificant indirect effect through, changes in the mediators over time. Results also showed that peer substance use was a direct positive predictor of problem use.