Objectivity in needs assessment practice: admission to a residential home

In 1997, the Dutch government installed independent agencies to assess the long-term care needs of individual clients and to give advice on the allocation of appropriate services. Needs assessors assess, among other things, the eligibility of clients requesting admission to a residential home. According to guidelines, needs assessors should do this objectively and independently from care providers and health care insurers. The present paper examines how needs assessors explore the clients' expressed needs, determine their normative needs and advise on allocation. Needs assessors perform these tasks in a situation where a clear professional framework is absent, and moreover, residential home capacity is limited. A qualitative study was undertaken, observing 13 house calls of clients requesting admission to a residential home. Furthermore, interviews were held with all needs assessors and a document analysis was made. It was found that needs assessors use comparable methods in exploring the clients' motivation and assessing their needs in the relevant areas, apparently using a professional framework. However, when transforming the needs of clients into an adequate allocation, needs assessors struggled with interpretation of criteria and included their personal ideas of services into the allocation decision. The paper concludes with the suggestion that further professionalisation may lead to a greater uniformity in needs assessment practice, and will assist needs assessors in the difficult task of transforming clients' needs into long-term care allocation advice.     

糖尿病周围神经病变血瘀证的客观化研究

目的：探讨糖尿病周围神经病变（DPN）中医血瘀证的相关检验及对证候客观化的意义。方法：分DPN属血瘀证者（Ⅰ组），DPN非血瘀证者（Ⅱ组），无并发症、非血瘀证的糖尿病患者（Ⅲ组），正常组（Ⅳ组）4组进行观察。对Ⅰ、Ⅱ、Ⅲ组进行糖尿病其他血管并发症、中医症状、舌象、脉象观察，各组均进行血糖、糖化血红蛋白、血液动力学、甲襞微循环、血脂及眼底镜检查，将结果进行对照。结果：DPN血瘀证者多合并其他血管并发症，临床表现以麻木（86．1％），舌质暗（100%）、淡（80．6％）最多见，血液动力学、甲襞微循环、血脂指标及眼底异常率均高于其他组，组间比较差异有显著性（P〈0．05或P〈0．01）。结论：DPN血瘀证与血液动力学、甲襞微循环、血脂异常及眼底改变关系最为密切。     

浅析我国多层次医疗保障体系的建立与完善

实现“病有所医”和“人人享有基本医疗卫生服务”是党的十七大提出的加快建设覆盖城乡居民的社会保障体系、以改善民生为重点的社会建设的六大任务之一。中国特色的医疗保障体系是“人人享有基本医疗卫生服务”的核心支柱，针对当前我国医疗保障体系存在的主要问题，建立多层次医疗保障体系的思路是“全覆盖、保基本、多补充、重救助、管理型、社会化、一体化”。     

An appropriate research paradigm for evaluating psychoanalytically-informed practices

Abstract

Psychoanalytically-informed practices are under pressure to evaluate their effectiveness via research. This article argues that some of the principles and assumptions of scientific research, qualitative as well as quantitative, are inappropriate for this purpose. A brief critique of the positivist paradigm as applied to human and social sciences research focuses on its incapacity to address meaning and experience in the context of the research relationship. The article goes on to discuss the inadequacy of statistical generalisation for the kinds of research questions relevant to psychoanalytically-informed practices and outlines an alternative set of principles for extrapolation from qualitative data and case studies. It uses examples from attachment research and the Hampstead Index project. An alternative approach involves an understanding of the production and analysis of research data informed both epistemologically and ontologically by psychoanalysis. Such an approach is discussed in relation to the ‘defended’ research subject, the idea of objectivity in Winnicott and Bion, transference and counteriransference in the research relationship and the exemplary supports provided for practitioners of infant observation to foster learning by experience.     

中医声诊客观化研究概况

中医声诊是传统中医诊疗方法的特色之一,有着丰富的传统医学理论基础,是历代中医医家临床经验的传承。随着现代医学和科技的迅速发展,中医声诊有客观化的需要,借助多学科、多种技术方法有利于发展声诊的现代化研究。就近年来中医声诊客观化研究的方法和成果进行简单的分析和概括。