人体解剖学教学中渗透医德教育的探讨

医学院校作为育医的摇篮.承当着培养医务人员的重任,对学生医德的教育负有义不容辞的责任。中国工程院院士钟南山教授指出,医德的内涵主要体现在“想方设法为患者看好病”,“想方设法”,意指医生对患者负责任的态度;“看好病”,则指医生应具备解决实际问题的能力[1]。通过思想道德品质教育,可以树立学生正确的世界观、人生观、价值观和医德观,全面影响学生的实践行为,为学生良好医德的形成提供思想基础和保证,从而达到培养德才兼备的医务工作者的教育目的。因此,学校应当将医德教育作为学校教育工作重中之重的问题,作为一名医学基础课程老师…     

谈“病人选医生”的伦理学意义

1　“病人选医生”使医生更能显现出人文伦理的关怀自古以来 ,医德关系中最基本的关系就是医患关系。医患之间的联系是一种人道的联系。而负载塑造医生品行的医德 ,对医生提出了要具有抚慰生命的善意和拯救生命的诚意的要求。这是因为 ,女人分娩、病人求医、老人诀世都是生命中最脆弱的时刻 ,最需要伦理的关怀 ,人道的体贴 ,人性的温暖。在中国的医学史上 ,有一串闪光的名字 :扁鹊、华佗、孙思邈、张仲景、吴登云……他们的业迹充分显示了人道的光辉。可随着医学技术的进步 ,医疗方式的“非人化” ,也使医患之间的温情趋于淡化 ,人性的温暖…     

论我国古代医家之医德

医学与其它科学技术最大的区别,就是医学的对象是人,因此医生的职业道德——医德就具有极为重要的意义。祖国医学认为:“医之道,必须先正己,然后正物”。就是说医师行医首先必须具有高尚的医德。在浩瀚的中医典籍里,有着极为丰富的有关医德的论述以及古代医家的许多嘉音懿行。明代医家缪希雍在《本草经疏》中所提出的“视医五则”可以说是古代医家之医德的概括。 1.对于病人必须有同情怜悯心情,体会病人的痛苦古代称医术为仁术,即医学是一种活人救命的技术。其服务对象直接是“人”。故明代医家龚廷贤在《万病回春》中说:“医道,古称仙道也,愿为活人”。因此作为医家对“人”对“生命”必须有无限的热爱精     

浅谈医德医风与医疗质量

医德是医务人员的职业道德 ,是调整医务工作者和病人之间、医务人员彼此之间、医务工作者和社会集团之间的行为准则和规范的总和。通俗地说 ,医德讲的是医务人员做人的规矩 ,即作为一个医务人员 ,哪些事情是可以做的 ,而且是应该做的 ;哪些是不可以做、不应该做的。医德医风与医疗质量是有机联系的 ,有的人长期以来 ,把医德医风与医疗质量割裂开来 ,这是认识上的错误。1　在医疗实践中医德的主要表现1.1　高度的责任心 :“健康所系 ,性命所托。”病人对医生是无限信赖的 ,为了治病 ,把自己的身体健康以致生命都托给了医生。医生对病人除负道…     

“救命恩人”和“上帝”

我国有一种习惯，把找医生看病叫做“求医”，即乞求医生来为自己或者亲人解除病痛。如果医生把病人的病治好了那就是“救命恩人”，所以，医生的职业伟大，神圣，很多人走上行医的道路也就是冲着这个而去的，虽然他们也接受医德医风的教育，也有法制观念，     

医德医风建设思路之我见

医德医风问题关系到发展社会主义市场经济、深化卫生体制改革、促进卫生事业发展 ;关系到社会主义精神文明建设 ;关系到提高医务工作者素质 ;关系到千家万户的健康幸福 ;关系到医家的前途命运 ,因而倍受党和政府、广大群众、医务工作者重视。笔者认为 ,医德医风建设是一个系统工程 ,为了搞好医德医风建设 ,笔者认为应该抓好“5个问题”。1　围绕一个中心不动摇　即围绕“以病人为中心”不动摇。市场经济本质上是服务经济 ,医疗工作主体必须坚决抛弃“以医生为中心 ,病人围着医生转”的陈腐观念 ,深刻认识“以病人为中心”是社会主义市场经济…     

医生的人格修养与医德实践

医生的人格修养与医德实践李兆亭医生必须有高尚的人格和优良的医德，我国古代早就说过“区乃仁术”、“夫医者非仁爱之士不可托也”。及至现代的白求恩大夫的“对工作极端负责任，对同志对人民极端热忱”，都表明为医者必须是一位道德高尚的人士。病人让医生看病，委之以...     

沉痛缅怀一代大师——我刊名誉顾问裘法祖院士

我国医学泰斗、一代大师裘法祖院士不幸逝世的噩耗，使我们万分悲痛。裘法祖院士是高尚医德医风的楷模。他仁心宅厚、大爱无疆，主张“医学归于大众”。早在1948年，裘法祖就创办了我国第一本医学科普刊物《大众医学》。他常说：“医术不论高低，医德最是重要。医生在技术上有高低之分，但在医德上必须是高尚的，一个好的医生应该做到急病人之所急，想病人之所想，把病人当作自已的亲人”。     

声音

收红包不一定不好,美国有很多医疗机构都靠社会捐赠维持运营。医生给病人看好病,病人拿出一部分钱表示感谢,我觉得这很正常。——中国工程院院士、上海交通大学医学院附属瑞金医院终身教授王振义说。     

假牙岂能假医镶

2000年7月1日,南昌市中级人民法院将靠“治牙”、“镶牙”坑人骗财的所谓“德国牙医”章俊理判处有期徒刑9年6个月,并处罚金100万元。该案受害者1124人获得民事赔款535万元。“德国牙医”曾在江西省人民医院工作,他难道也属于庸医吗? 庸医不一定都是游医,但游医多为庸医。医德高尚的医生,总是为病人着想;缺乏医德的庸医,首先考虑的是如何让病人从口袋里多掏出一些钱来。工程师李洪来门诊口腔科就诊,问     

Intensive care in a general hospital: demographics,utilization and outcomes

Introduction

Intensive care units (ICU) in Irish academic centres are known to fare as well as their international counterparts. Our aim in this study was to characterise the role and outcomes of an ICU in a smaller Irish hospital and to compare these to international best practice.

Methods

We reviewed admissions of patients to the ICU of St. Luke’s Hospital, Kilkenny. Patient demographics, indications for admission, and outcomes were all recorded and analysed. Sequential organ failure assessment (SOFA) scores were calculated.

Results

Forty-three patients were included in our study, 33 (76.7 %) of which were emergency admissions. Median length of stay was 2 days. The observed mortality rate in our cohort was 20.9 %. The median SOFA score in patients admitted was 7. Higher median SOFA scores on admission were predictive of mortality. The ICU occupancy rate during the duration of our study was 98 %, with only 15 (35.7 %) of admissions to ICU occurring within core working hours.

Conclusion

Critical care can be provided safely and in line with current best practice in smaller Irish hospitals. There is a cohort of patients for whom care may be best provided in a tertiary centre, how best to provide for these patients will likely be achieved by early identification (e.g. with SOFA score). Bed capacity issues remain problematic.     

卒中单元的概念及国内现状

脑卒中是致死和致残的常见原因。卒中单元是指有组织地管理脑卒中住院患者。相比普通病房,卒中单元治疗的患者能明显提高早期日常生活能力,减少神经功能缺损,提高回归社会的能力,不增加患者花费。现有循证医学研究证据表明,目前脑卒中治疗的最有效措施是卒中单元。但我国的卒中单元还存在许多问题,需共同努力建立有中国特色的卒中单元。     

A review of perioperative anaphylaxis at a Singapore tertiary hospital

INTRODUCTION

Perioperative anaphylaxis is an anaesthetic emergency, but its incidence is not well described in the local literature. This retrospective study aims to look at a group of patients who had perioperative anaphylaxis in our institution.

METHODS

We conducted a retrospective review of electronic databases and clinical case sheets, and identified 34 patients who had possible perioperative anaphylaxis during anaesthesia in our institution between 1 January 2007 and 30 April 2012.

RESULTS

After reviewing clinical and biochemical data, we found that 16 out of 151,876 patients who underwent surgery had confirmed perioperative anaphylaxis, an incidence of 1:10,000. Neuromuscular blockers were identified as the most common causative agent for perioperative anaphylaxis. The offending agent could not be identified in seven patients.

CONCLUSION

To the best of our knowledge, this is the first study in Southeast Asia on the incidence of perioperative anaphylaxis. Having a preoperative history of allergy did not seem to predispose patients to the subsequent development of perioperative anaphylaxis.     

Ethical care at the end of life

In treating dying patients, who by virtue of their physical and emotional situation are frail and vulnerable, physicians must meet a high standard of professional, ethical care. Such a standard is based upon a philosophy of care that recognizes the patients' inherent worth as human beings and their uniqueness as individuals. The ethical and virtuous physician will practice in accordance with the principles of biomedical ethics that form the foundations of thought and treatment approaches in this area and will seek to do the best for the patient and the family. "Doing the best" includes respecting autonomy through gentle truth-telling, helping the patient and family to set treatment goals, and providing for symptom control, continuing attentive care and accompaniment throughout the course of the illness. Total care includes physical, emotional and spiritual aspects, is sensitive to cultural values and is best provided by an interdisciplinary team. Practices of symptom control in routine care and in crisis situations, as well as the cessation and non-initiation of treatment, will have as their goals the relief and comfort of the patient. The ethical physician will not act with the intention of bringing about the death of the patient, whether by ordering medication in excess of that required for symptom control, administering a lethal injection or any other means.     

应用乳头内组织瓣修复重度乳头内陷

从1992年至今，应用乳头内组织瓣法修复重度乳头内陷病人8例（14只）。该法不仅充分松解了乳头内纤维挛缩组织，而且填补了乳头内组织的缺损，有针对性的纠正主要病理改变；此外，基底部逐层环形封闭式缝合，有效防止组织瓣下陷。经3月～4年的随访，效果良好，恒定可靠，为目前治疗重度及顽固性乳头内陷的最有效方法。     

Futility has no utility in resuscitation medicine

"Futility" is a word which means the absence of benefit. It has been used to describe an absence of utility in resuscitation endeavours but it fails to do this. Futility does not consider the harms of resuscitation and we should consider the balance of benefit and harm that results from our resuscitation endeavours. If a resuscitation is futile then any harm that ensues will bring about an unfavourable benefit/harm balance. However, even if the endeavour is not futile, by any definition, the benefit/harm balance may still be unfavourable if the harms that ensue are great. It is unlikely that we will ever achieve a consensus definition of futility and certainly not one that is applicable to every patient undergoing resuscitation. In the meantime our use of the term "futile", in the mistaken belief that it tells us whether it is worth resuscitating or not, has no utility as it will never succeed in telling us this. Furthermore we risk causing offence by use of the term and we risk harming the patient's autonomy by using futility as an overriding force. Instead we should consider the utility of our endeavours, for which an assessment of the harms of resuscitation should be added to our considerations of its benefit. This balance of benefit and harm should then be evaluated as best it can be from the patient's perspective. The words futile and futility should be abandoned by resuscitationists.     

开胸术后急性疼痛治疗的国内现状

术后急性疼痛是开胸手术后最常见和最需紧急处理的问题之一,治疗此类疼痛有多种手段,目前尚无哪一种镇痛方式被公认为最佳,相对有效的镇痛模式是多模式镇痛.本文针对现阶段主要采用的几种镇痛手段进行简要综述.     

Staffing shortfall plagues radiation oncology.

Canada's radiation oncologists say a staffing crisis looms within their specialty. A growing number of cancer patients means resources are being stretched, doctors are facing additional stress and waiting lists are becoming longer. "I see no way that we can conceive of meeting our needs by 2000," says Dr. Tom Keane of Toronto's Princess Margaret Hospital. The staffing shortage also extends to the medical physicists who run the radiotherapy machines. Many are being attracted to the US by higher salaries.     

七年制医学生骨科临床见习教学实践与探讨

临床见习是让医学生由理论学习进入临床实践的重要阶段。本文通过总结七年制医学生骨科见习教学的经验,包括合理安排教学内容;选择适当病例,保护患者权利;充分利用多种教学手段;多种教学方法相结合,提高教学效果;以身作则,培养医学生职业道德,以期进一步提高七年制骨科见习教学的效果。     

The implantable "Infusaid" infusion pump. The Sydney experience using 5-fluorouracil

The experience is reported of the use of the totally implantable "Infusaid" infusion pump in the treatment of 14 patients in our combined clinics for metastatic carcinoma in the liver by means of the antimetabolite 5-FU. At the time of this study the more active antimetabolite 5-FUDR was not available. A comparison is made of overseas reports of the use of 5-FUDR in the Infusaid infusion pump with the experience, in our clinic, of the use of 5-FU.