对医院现代化的认识与实践

作者首先对医院的现代化进行了论述，他认为现代化医院包括：（1）医院的建筑现代化，即主体建筑及配套设施的现代化和与主体建筑相配套的环境现代化，体现在功能化、生态化、人性化、智能化与艺术性。（2）医院的科技现代化，即比特化和管理者理念和素质等体现出现代化。其次阐述了作者所在医院在二期建设时对上述理论进行了实践。     

中、西医对急性肺损伤/急性呼吸窘迫综合征的认识及展望

背景 急性肺损伤/急性呼吸窘迫综合征(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)由肺内外多种病因引起,其发病机制复杂,病死率高. 目的 文章拟将中、西医两方面对ALI/ARDS的研究作一浅显的对比回顾c内容 综合相关文献,西医和中医无论在病理机制还是治疗方面都各有研究,其中既有相通之处又各成体系. 趋向 为中西医结合治疗ALI/ARDS提供新的线索.     

试论医学类个案报道写作的学术意义及正确认识

个案报道（Case Report）作为一种学术论文文体越来越被轻视,在学术风气日渐浮气的当下尤甚,这是一种不良倾向。对个案报道类医学文献存在的认识误区已干扰到我们对它的开发和利用。我们应该如何正确认识个案报道这种文体,撰写高质量个案报道的写作要件有哪些,是本文拟要探讨的一个问题。     

Empathic understanding: Constructing an evaluation scale from the microcounseling approach

Abstract The Empathic Understanding Scale measures the depth of the nurse–patient relationship. As a nurse cares for a patient it is necessary to first establish a relationship. The author identified empathic understanding as the key concept for this study. The primary theme was to develop a scale to measure the nurse's level of empathic understanding of the patient. The purpose of the study was to examine a 23‐item questionnaire using the microcounseling model to prove whether empathy is an effective tool in establishing a nurse–patient relationship. Using these results, factors were extracted to measure the level of the nurse's empathic understanding of the patient. Eighteen subjects participated in the pilot study: eight nurses employed by the psychiatric ward of one of Shizuoka's prefectural hospitals, Yoshinso, and 10 students learning to be public health workers. All 18 subjects verbally agreed to participate in the study. Data collection was through experimental interviews according to microtraining models and through questionnaires comprising four elements: moral, emotional, cognitive and communication action. The results were analyzed by principle factor analysis, two‐way analysis of variance and multiple regression analysis of variance. Analysis resulted in four factors being extracted. Using the Emotional Empathy Scale for comparison, the content validity of those factors was confirmed. In the second study, these four factors were used as an evaluation instrument in the form of a list of 20 items of evaluation. Measurements were derived by evaluating the 327 nursing students who were the subjects for this study. The subjects performed pseudo‐counseling role plays based on the microcounseling method. Five evaluators studied the counselor’s behavior and attitude by observing the interaction between the client and counselor roles as the subjects performed role plays. A Likert scale was used to collect data and the data were analyzed by principle factor analysis. The Empathic Understanding Scale consists of four factors: ‘acceptance attitude’, ‘cognitive awareness attitude’, ‘reflective attitude regarding emotions and meaning’ and ‘verbalization prompting attitude’. These four factor structure groups that were extracted were found to be the same in both the pilot study and the second study. In the second study, however, a more valid and reliable Empathic Understanding Scale was established.     

2010年长沙市城区小学生早餐状况调查

[目的]了解长沙市小学生对早餐的认识、态度及行为状况,为今后的健康教育提供干预依据。[方法]2010年,在长沙市城区16所不同层次的小学,抽取2~6年级小学生2 095名进行问卷调查。[结果]调查2 095人,59.76%对自己的早餐问题表示关心;65.16%认为吃早餐是为了补充营养;每天坚持吃早餐的占82.82%,不吃早餐的占2.58%。不吃早餐的54人中,不吃早餐的原因主要是父母太忙没时间准备早餐(占29.63%)和早上睡过头没时间吃早餐(占14.81%)。调查2 095人,有挑食行为的占43.63%。认为长沙市的早餐应该在卫生、营养均衡方面加以改进的分别占27.54%、36.80%。[结论]长沙市小学生的早餐存在较多问题,部分小学生对早餐的重要性认识不足。     

幽门螺杆菌新国际共识解读

为推动和规范幽门螺杆菌(H.pylori)相关疾病的防治,自2000年以来国际和国内先后制定了若干共识意见。最近几年来,国际上又先后举行了一些H.pylori感染处理的共识会议,包括第二次亚太共识会议、世界胃肠病组织(WGO)发展中国家的共识会议和第四次Maastricht共识会议。我国预定2012年春天召开第四次H.pylori处理共识会议。这些新共识对我们目前临床工作和今年国内共识的修订均有一定参考价值。为此,结合我国国情对这些新共识进行解读,重点是何种方案治疗最为合适。     

General practitioners’ and psychiatrists’ responses to emotional disclosures in patients with depression

Objective

To investigate general practitioners’ (GPs’) and psychiatrists’ responses to emotional disclosures in consultations with patients with depression.

Methods

Thirteen patient consultations with GPs and 17 with psychiatrists were video-recorded and then analyzed using conversation analysis (CA).

Results

Psychiatrists responded to patients’ emotional disclosures by attempting to clarify symptoms, by rational argumentation, or by offering an interpretation of the emotions from their own perspectives. GPs responded by claiming to understand the emotions or by formulating the patients’ statements, but without further exploring the emotions.

Conclusion

GPs displayed a greater engagement with patients’ emotions than psychiatrists. Their approach could be described as empathic, corresponding to a mentalizing stance. The different approaches taken by psychiatrists could represent conceptual differences and might affect fruitful interdisciplinary work. Psychiatric nurses’ responses to patients’ emotions must also be studied to complete our knowledge from psychiatry.

Practice implications

Experiences from training in mentalization could be used to develop physicians’ empathic or mentalizing approach. As most patients with depression are treated in primary care, developing GPs’ mentalizing capacity instead of offering didactic training could have a substantial effect in the population.     

高职生领悟社会支持、孤独感与网络成瘾倾向

目的了解高职生网络成瘾状况,探讨领悟社会支持、孤独感对网络成瘾的影响。方法采用中文网络成瘾修订版(CIAS-R)、领悟社会支持量表(PSSS)、孤独感量表(UCLA)对广州两所高职院校共657名高职生进行测试。结果①网络成瘾检出率为2.3%,网络依赖为16%;②低领悟社会支持组高职生在网络成瘾倾向得分高于中、高领悟社会支持组(F=5.44,P0.01);处于严重孤独水平的高职生在网络成瘾倾向上得分高于其他各组(F=9.07,P0.01);③领悟社会支持得分与网络成瘾倾向呈负相关(P0.01);孤独感与网络成瘾总分及各维度呈正相关(P0.01);领悟社会支持总分及各维度与孤独感程度存在负相关(P0.01);④孤独感在领悟社会支持与网络成瘾中的中介作用显著,中介率为69.6%。结论高职生网络成瘾问题应得到更多关注。对领悟社会支持和孤独感进行测定及采取有效改善措施,有助于对高职生网络成瘾进行干预。     

院前急救糖尿病低血糖昏迷的救治体会

目的：探讨在院前急救中对糖尿病低血糖昏迷患者的救治。方法：回顾性分析2012年2月至2013年1月石景山急救分中心接诊的25例糖尿病低血糖昏迷患者的临床资料,患者年龄均〉65岁。结果：25例患者在6~18 min内逐渐清醒,均安全送至医院治疗。结论：院前快速反应使患者在第一时间得到较为合理的救治,是提高抢救成功率、减少并发症的关键,并且为院内救治创造了条件。     

外科手术患者对手术知情同意书理解现状调查分析

目的通过问卷调查,分析手术知情同意书签署中存在的问题,为医务人员更好履行告知义务提供依据。方法对801例签署手术同意书患者进行调查,使用SPSS13．0软件,采用卡方检验的分析调查结果。结果调查对象对手术同意书内容理解方面,只有27．22％的患者或受托人能充分理解手术中存在的风险,39．58％的患者或受托人知道手术中风险的应对措施;调查对象对手术同意书法律地位的认识方面,28．96％的患者和受托人知晓患者和受托人签署的同意书法律效力相同。结论应加强法律法规知识培训,提高医师的沟通能力,充分尊重患者的知情同意权。