卫生事业单位实行聘用制及相关问题的探讨

就实行聘用制度后卫生事业单位在人员进入方式、聘用后管理及人员退出中注意的问题作了探讨,并提出了解决问题的对策。     

Patient satisfaction in outpatient cancer care: a prospective survey using The PASQOC® questionnaire

STUDY OBJECTIVES: To examine how outpatient cancer patients assess their cancer care in private oncology practices and day hospitals, and to identify the extent to which staff meet the expectations of their patients. SETTING: Private practices (n = 41) and day hospitals (n = 8) in Germany, including 16 "repeater" practices who had already participated in the 2002 Patient Satisfaction and Quality in Oncological Care (PASQOC) survey. PARTICIPANTS: n = 4,615 patients with cancer. Diagnoses: 25% breast cancer, 21% colorectal cancer, 12% haematologic malignancies, 11% lymphomas; mean age 63.5 years; 57% female; n = 1,639 patients from repeater practices. MEASUREMENTS: The 2004 PASQOC questionnaire contained 63 problem-oriented items which covered 15 different dimensions of care. Practice staff invited their patients to participate and surveys were mailed to all sampled patients. For statistical analysis, the problem frequency (PF) was calculated for each item. RESULTS: Of 5,600 patients who received the questionnaire, 4,615 replied (response rate: 82%). The best results were obtained for the dimensions "further support in daily life" (3% PF), "nurses" (5% PF), and "physician-patient-relationship" (8% PF). Potential for improvement was most pronounced for "handling of side effects" (39% PF), "partnership and shared decision making" (30% PF), "side effects" (30% PF) and "communication with other patients" (26% PF). Considerable differences in PFs between practices were observed. Mean results from the 16 repeater practices revealed only few changes compared to the 2002 PASQOC survey, although some practices had greatly improved their performance. CONCLUSIONS: The PASQOC questionnaire identified strengths and weaknesses of outpatient care for cancer patients. By providing a comparison with other practices, PASQOC can help staff of individual practices to improve their performance.     

Attempting to solve the problem of pain: a questionnaire study in acute and chronic pain patients

When faced with the problem of pain one can attempt a solution aimed at relief (assimilation) or a solution aimed at acceptance (accommodation). Using this dual process model of adaptation to pain, this study compares acute and chronic pain patients on their approach to problem solving. Three hundred and sixty-four patients were recruited from clinical settings, 303 with chronic pain and 61 with acute pain, and completed a range of measures of both affect and pain-related behavior, including the Pain Solutions Questionnaire. The effects of overall duration of pain were also investigated. Chronic pain patients reported greater disability and catastrophic thinking about pain than acute pain patients, and assimilative coping was associated with greater disability, greater attention to pain, and more catastrophic thinking about pain, beyond the effects of demographic variables and pain severity. Pain duration did not moderate these associations. Only in the case of catastrophic thinking about pain was it found that the effects of assimilative coping were moderated by pain duration. For chronic pain patients, catastrophic thinking about pain was greater when assimilative coping was higher. These results are discussed within the context of a goal directed motivational model of adaptation to chronic pain.     

Utility of Liver Function Tests for Screening “Alcohol Abusers” Who Are Not Severely Dependent on Alcohol

This study evaluated the utility of using liver function tests to identify low dependence outpatient “alcohol abusers” (N = 253) and for evaluating changes in their drinking over the course of treatment. Despite drinking at levels considered to pose a health risk (i.e., drinking on 72% of all days in the year prior to treatment and averaging 6.3 drinks per drinking day), nearly two-thirds had normal liver function tests at treatment entry. It is concluded that for problem drinkers the cost of using liver function tests outweighs the benefits.     

Introducing the Hero Complex and the Mythic Iconic Pathway of Problem Gambling

Early research into the motivations behind problem gambling reflected separate paradigms of thought splitting our understanding of the gambler into divergent categories. However, over the past 25 years, problem gambling is now best understood to arise from biological, environmental, social, and psychological processes, and is now encapsulated under the biopsychosocial model. While, the biopsychosocial model brings a great degree of understanding regarding the etiology and process becoming a problem gambler, it is clear that further research is needed to improve theoretical perspectives that identify causal trajectories that underlie gambling related problems amongst sub-groups of problem gamblers. One line of research that has gone understudied with respect to exploring such causal paths is the Mythic Iconic Pathway of problem gambling. Such a pathway conceptualizes gambling pathology as a life-world phenomenon that arises within an individual who filters perceptions of the self and world through a hero’s complex. Thus, this paper will outline the Mythic Iconic Pathway, including its phenomenological processes, and describe the key therapeutic insights and implications to consider when adopting such a novel approach toward understanding and treating the problem gambler.     

高等医学教育的特点及其相关问题的思考

高等医学教育是高等教育的重要组成部分,与其他高等专业教育具有同一性,同时又有自身的特殊性,因为与医学教育直接联系在一起的是人们的生命和健康。本文通过对医学教育特殊性及其相关问题的分析和思考,以期得到社会及医学教育界同行的共同关注,使我国的高等医学教育更加适合社会发展的需求。     

农村中学生问题行为倾向及影响因素研究

目的：早期发现农村中学生的问题行为倾向，并探讨其影响因素，为早期干预提供依据。方法；用《问题行为早期发现测验（PPCT)、《艾森克个性问卷(EPQ)》、《症状自评量表(SCL-90)》、自行设计的《一般情况调查表》调查261名13-19岁的农村中学生。结果：农村中学生问题行为倾向总检出率为38.4%。检出率最高的是学习不适应21.7％，其次为对人际关系不适应15.1％。Logistic回归分析出的影响因素有：年龄、学习成绩、父亲教育方式、学生精神质倾向(P)、抑郁、焦虑、偏执、人际关系敏感、敌对的负性情绪。结论：早期诊断问题行为倾向，针对主要的影响因素，从家庭、学校和社会入手，及早干预指导，可避免或减少问题行为的发生。     

Attitudes Toward Problem Drinkers, Revisited: Patient-Therapist Factors Contributing to the Differential Treatment of Patients with Alcohol Problems

Although there are many treatment alternative open to people with drinking problems, health professionals still exhibit negative attitudes towards alcoholics. In a previous study, the author demonstrated that those patients who were self-labelled alcoholics were treated in a less preferential manner than those who did not identify as such. This study used both overt and unobtrusive measures to determine whether negative attitudes of intake interviewers towards problem drinkers were elicited by the patients' self-label as an alcoholic or by other variables related to perceived treatment outcome. Pre- and postinterview data on patient likability, doctor's eagerness to work with the patient, interview content, treatment disposition, and patient compliance were collected from first-time patients, and from their interviewers, in the walk-in psychiatry and alcohol treatment units of a large, urban teaching hospital. The results elucidate how stereotypes interact with patient characteristics to influence both professional behavior and patient compliance.     

医药职业教育信息化教学的现实背景、存在 问题及解决路径

医药职业教育信息化教学是实现教育现代化和深化教育改革的重要路径。该文深入探讨了医药职业教育信息化教学发展面临的现实背景，并在梳理分析现阶段医药职业教育信息化教学存在信息技术融合层次较低、教学主体信息化能力较弱、医药职业教育精品在线课程资源短缺等问题的基础上，提出了相应的解决路径：实施教学革命，实现信息技术与教学融合创新；开展全方位能力培养，增强教学主体信息化能力；以创新为导向，积极打造医药职业教育精品课程。     

Functional analysis and treatment of problem behavior exhibited by children with fragile X syndrome

The efficacy of function-based interventions for the treatment of severe problem behavior exhibited by individuals with intellectual and developmental disabilities (IDD) is well established. However, few studies have reported on behavioral interventions in fragile X syndrome (FXS) specifically. The present study is a consecutive case-series analysis that reports on functional analysis and treatment of problem behavior of nine children with FXS. Assessment findings were consistent with previous research indicating that among individuals with FXS, problem behavior is more commonly maintained by escape from demands and access to tangible items, relative to the broader population of individuals with IDD. Functional analysis-based behavioral interventions resulted in a mean reduction in problem behavior of 95.2% across the nine participants. Additionally, generalization of treatment effects from controlled clinical settings to home, school, and community was demonstrated. The current findings suggest that function-based behavioral interventions shown to be effective with the broader population of individuals with IDD are also effective for individuals with FXS. Our results in combination with those of previous studies describing functional analysis outcomes provide additional evidence for a unique functional behavioral phenotype for severe problem behavior in individuals with FXS. Implications of study findings for early intervention and prevention of problem behavior in children with FXS are discussed.