食管裂孔疝的外科治疗进展

食管裂孔疝即腹腔内脏器经食管裂孔疝入胸腔,并引发烧心、反酸等消化道及其他非消化道症状。按其解剖及临床表现可分为四型。通过病史采集、体格检查及一系列客观检查可以明确食管裂孔疝的诊断、分型及疾病进展程度。食管裂孔滑动疝并发反流、食管裂孔旁疝合并明显症状、混合型及多器官型食管裂孔疝或内科治疗效果不佳的通常应优先考虑手术治疗,以消除疝形成的因素,控制胃食管反流。食管裂孔疝手术目前通常采取腹腔镜下疝修补、补片加强及胃底折叠术,同时也存在食管延长、胃固定等其他替代术式。围手术期通过积极地控制风险因素,有助于降低各类术中、术后并发症风险及复发率。对复发、儿童及肥胖等特殊患者,也应视患者条件积极实施手术治疗。随着研究的进一步深入,食管裂孔疝手术在手术入路、补片材料、复发及并发症控制、日间手术模式应用等方面将取得更大的进展。     

关于医疗、科研的一点认识

临床医疗是医院的根本使命,在权重上医疗自然重于科研.医疗实践是科研的出发点与归宿,决定了科研的基本走向.当前,科研工作受到前所未有的重视,科研作为医疗人员绩效考核的权重过大,偏离了医院的根本使命,会对科研、医疗、医护人员乃至整个社会造成伤害.SCI论文与临床关系不密切,不宜用来评价临床医师的水准.应该建立科学的考评机制,考核标准应细化、全面,对科研的奖励应适度.对于医护人员的考核应以医疗为主、科研为辅.     

临床医学整合：中心化整合关键在于观念转变

医学转型的实质是推进医学的整合,微观层面以临床医学的整合为核心部分,宏观上则以临床医学与预防医学的整合为核心。在诸多整合之中,以临床医学的整合最为迫切,它是整个医学整合过程中的基础和开端。当前进行的临床中心化整合似乎已成为一种主导的趋势,然而,如何进行中心化整合却仍然存在诸多问题需要探讨,某些医院对专科化的热衷和偏爱更令人担忧,医学资本的诱惑也是当今临床整合的一道障碍,因此,医学整合任重而道远,不仅需要医学形式上的重组,更需要有观念上的根本转变。     

ART伦理督导的实践与评价

在生殖中心(医院)中,将伦理原则的学习与技术规范的掌握相结合,将伦理学评价与员工的奖惩机制相结合,将伦理学研究与管理骨干的培养相结合,将伦理原则的贯彻与工作总结相结合;发挥医学伦理委员会监督的权威作用,重视群众监督手段的督促作用,借助国家行政督导机构和行业法规的震慑作用,是ART增强道德约束能力的有效机制。     

对影响病人满意度相关因素的医学伦理思考

设计调查问卷对深圳某基层医院实施病人满意度调查及相关因素的医学伦理分析。结果显示病人满意度不高,门急诊病人的总满意度明显低于住院病人;病人对服务态度、就医环境和诊疗费用等都较不满意。其中医院未能遵循及时、准确、有效、择优和自主原则是主要影响因素。     

In-session gaming as a tool in treating adolescent problematic gaming

For some adolescent gamers, playing online games may become problematic, impairing functioning in personal, family, and other life domains. Parental and family factors are known to influence the odds that adolescents may develop problematic gaming (PG), negative parenting and conflictual family dynamics increasing the risk, whereas positive parenting and developmentally supportive family dynamics protecting against PG. This suggests that a treatment for adolescent PG should not only address the gaming behaviors and personal characteristics of the youth, but also the parental and family domains. An established research-supported treatment meeting these requirements is multidimensional family therapy (MDFT), which we adapted for use as adolescent PG treatment. We report here on one adaptation, applying in-session gaming. In-session demonstration of the “problem behavior” is feasible and informative in PG. In the opening stage of therapy, we use in-session gaming to establish an alliance between the therapist and the youth. By inviting them to play games, the therapist demonstrates that they are taken seriously, thus boosting treatment motivation. Later in treatment, gaming is introduced in family sessions, offering useful opportunities to intervene in family members' perspectives and interactional patterns revealed in vivo as the youth plays the game. These sessions can trigger strong emotions and reactions from the parents and youth and give rise to maladaptive transactions between the family members, thus offering ways to facilitate new discussions and experiences of each other. The insights gained from the game demonstration sessions aid the therapeutic process, more so than mere discussion about gaming.     

医学生临床实习应掌握的几种哲学思维方式

为适应全球卫生事业的迅猛发展,面对医学教育落后于医学发展的现状,转化医学教育迫在眉睫。在第三代“以系统为基础”的教育改革中,培养医学生的哲学思维无疑是其重要环节之一。思维方式必须在医学生步入临床时就要开始正确培养,一旦开始阶段就养成不正确的思维方式、不但会导致医疗过程中的失误,而且再想改变将会有很大难度。本文通过对医学哲学重要性的探讨,剖析医学生哲学思维的不足,阐述了医学生,临床实习过程中应掌握的几种哲学思维方式。旨在提高医学生的哲学理念,促进以岗位胜任能力为导向的医学教育转型发展。     

Association between intimate partner violence during pregnancy and maternal pregnancy complications among recently delivered women in Bangladesh

Intimate partner violence (IPV), an actual or threatened physical, sexual, or psychological abuse by a current or former partner or spouse, is a common global public health issue. Understanding both the prevalence of IPV during pregnancy and its potential impact on the health of pregnant women is important for the development and implementation of interventions to prevent maternal morbidity and mortality. The purpose of this study was to explore the association between maternal experiences of IPV during pregnancy and pregnancy complications. A health‐facility‐based cross‐sectional study was conducted from July 2015 to April 2016 among 400 randomly selected women who were admitted to the postnatal wards of Rajshahi Medical College Hospital for delivery. Data were collected through face‐to‐face interviews using a structured questionnaire. Multivariable logistic regressions were performed to assess relationships between variables of interest after controlling for potential confounders. Results indicated that 39.0% of women reported physical IPV and 26.3% of women reported sexual IPV during pregnancy. Additionally, 69.5% of women experienced medical complications (MCs); of this group, 44.3% experienced obstetric complications (OCs) and 79.3% experienced any pregnancy complication (AC) during their last pregnancy. The experience of physical IPV during pregnancy was significantly associated with the experience of MCs (adjusted odds ratio (AOR): 2.05, 95% confidence interval (CI): 1.15–4.01), OCs (AOR: 4.23, 95% CI: 2.01–7.12) and AC (AOR: 5.26, 95% CI: 2.98–10.52). Women who experienced sexual IPV during pregnancy were also at increased risk of suffering from any MC, any OC, and AC. Maternal experience of IPV during pregnancy is positively associated with pregnancy complications. Preventing IPV directed at pregnant women might reduce maternal morbidity and mortality in Bangladesh.

     

A Single-Subject Evaluation of the Treatment of Morphing Fear

We present a single-subject prospective outcome study of a man with severe morphing fear and long history of OCD who was not helped by previous interventions, and who received an adapted form of cognitive behavior therapy (CBT) as part of this study. Treatment consisted of a cognitively focused approach tailored to address his fear of morphing and included developing a stronger sense of self-stability. We describe the details of the case, the treatment protocol, and the therapeutic outcomes as assessed over 36 weeks by questionnaires, rating scales, and semistructured interviews. The intervention was effective in eradicating the patient’s morphing fears and reducing other symptoms of OCD, anxiety, and depression. The presented case illustrates the need to appropriately conceptualize, assess, and address the specific nature of morphing fear symptoms in treatment.