医疗文书签字扩大化失去意义的原因分析

随着近年医患关系的紧张,越来越多的医疗工作需要履行签字手续,呈现了签字扩大化的态势。签字扩大化是防御性医疗的一种表现形式,但并未带来医疗纠纷减少,也不是医疗纠纷产生的主要原因,又给医疗工作增加了繁琐程度,而且并未达到知情同意的内涵。所以,签字扩大化失去了其应有的意义。     

A preliminary examination of the effect of massage on state body image

Evidence suggests positive effects of massage on psychological health; however, little is known about the effects of massage on body image. This research examined the effect of massage on state body image as well as relations between trait body image and attitudes toward massage. Forty-nine female university students were randomly assigned to either a massage condition or a control condition. It was hypothesized that participants in the massage condition would report improved state body image following the intervention when compared to participants in the control condition. As predicted, participants in the massage condition reported a more favorable state body image than participants in the control condition post-manipulation. Certain body image evaluations were moderately associated with views that massage is pleasurable, with the link between Body Areas Satisfaction and viewing massage as pleasurable reaching significance. Research is needed to determine the mechanism/s through which massage improves body image.     

从医学看巫术、宗教与科学的关系

医学是巫术、宗教、科学三者联系最多的门类,巫术在我国-始终盛行。近２０年有所抬头 ,其原因非常复杂。区别巫术与宗教、巫术与科学,是减少巫术危害最基本的方法。就此问题进行了深入阐述。     

百年回眸:免疫学研究进展与医学

免疫学与医学有着紧密的联系。在免疫学的经验时期,中国医学家发明了人痘接种预防天花;１７９８年牛痘苗的发明,最终导致开花在地球上被消灭。在巴斯德时代,由于病原微生物的发现,人工主动免疫、人工被动免疫和三大血清学技术（沉淀、凝集、补体结合反应）使免疫学的应用扩大到对多种传染病的预防、诊断与治疗,极大地促进了医学的发展。７０年代以来,由于胸腺功能的发现,淋巴细胞功能的发现阐明了免疫系统的存在;克隆选择学     

Recognizing Racit Knowledge in Medical Epistemology

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine.An erratum to this article can be found at     

Saints-protectors from Snake Bite: A Short Overview and a Tentative Analysis

A short overview of several saints, including Peter, Paul, John, George, Hilarius, Hubert, and Gaudentius, venerated in Christian tradition as protectors from snake bite, is offered as an introduction to a more substantial debate on the factors determining the choice of protectors in folk medicine, as well as on the possible adjuvant effect of (auto)suggestive therapy obtained by the invocation of saints.     

The Role of Religion and Spirituality in Medical Patients in Germany

Using the new developed SpREUK questionnaire (version 1.0b), we examined how German patients (n = 129) with cancer, multiple sclerosis and other diseases view the impact of spirituality and religiosity (SpR) on their health and how they cope with illness. Patients with both a religious and spiritual attitude (32%) had significantly higher values in the sub-scales dealing with the search for meaningful support, and the stabilizing effects of SpR than patients without such attitudes (20%), while patients with a non-spiritual religious attitude (35%) had lower perception of the beneficial effects of their SpR and had significantly lower scores in the search for meaningful support sub-scale. Just half of the non-spiritual religious group and 42% of religious patients are convinced that finding an access to a spiritual source has a positive influence on their illness.     

Spiritual Beliefs and Barriers Among Managed Care Practitioners

Purpose: Ninety percent of American adults believe in God and 82% pray weekly. A majority wants their physicians to address spirituality during their health care visit. However, clinicians incorporate spiritual discussion in less than 20% of visits. Our objectives were to measure clinician beliefs and identify perceived barriers to integrating spirituality into patient care in a statewide, primary care, managed care group. Methods: Practitioners completed a 30-item survey including demographics and religious involvement (DUREL), spirituality in patient care (SPC), and barriers (BAR). We analyzed data using frequencies, means, standard deviations, and ANOVA. Findings: Clinicians had a range of religious denominations (67% Christian, 14% Jewish, 11% Muslim, Hindu or Buddhist, 8% agnostic), were 57% female and 24% had training in spirituality. Sixty-six percent reported experiencing the divine. Ninety-five percent felt that a patients spiritual outlook was important to handling health difficulties and 68% percent agreed that addressing spirituality was part of the physicians role. Ninety-five percent of our managed care group noted 8lack of time as an important barrier, lack of training was indicated by 69%, and 21% cited fear of response from administration. Conclusions: Managed care practitioners in a time constrained setting were spiritual themselves and believed this to be important to patients. Respondents indicated barriers of time and training to implementing these beliefs. Comparing responses from our group to those in other published surveys on clinician spirituality, we find similar concerns. Clinician education may overcome these barriers and improve ability to more fully meet their patients expressed needs regarding spirituality and beliefs.*This material has previously been presented as an abstract at the Culture and End of Life Conference, Association of Medical Colleges Spirituality, Kansas City, MO, September 12–14, 2002.Project supported by the Foundation for Spirituality in Medicine, Baltimore, MD     

Mentoring in the Academic Medical Setting: The Gender Gap

Mentoring is an essential part of success in the academic medical center. The provision of effective mentoring is key to the success of the increasing numbers of women entering medicine. However, the gender distribution within the hierarchy of medicine has not changed in that the power still resides with men in the system. Currently, men are attempting to mentor women, and so as the proportion of women in medicine continues to grow, they will become more influential in this setting and will become increasingly responsible for providing mentoring to men. In either case, effective communication across gender lines is an essential aspect of the mentoring process. Psychologists in academic medical settings can provide guidance to faculty and staff on the critical aspects of social development and communication, which may affect how women and men are mentored and the success of this mentoring process, whether across or within gender lines.     

在西方医药审判中的一个亮点--科学哲学

科学证据不仅在司法审判中起着极其重要的作用,而且在科研成果的评价中也是不可取代的,但是在审判和科研成果评估中,对“科学是什么”这样一个更深层次的问题－科学哲学问题,历来没有得到应有的重视,通过美国止吐药本涤汀前后历时20年的审判历程,突出科学哲学在医药审判实践中的地位。