Caregiver burden and the medical ethos

Are physicians sometimes morally required to ease caregiver burden? In our paper we defend an affirmative answer to this question. First, we examine the well-established principle that medical care should be centered on the patient. We argue that although this principle seems to give physicians some leeway to lessen caregivers' suffering, it is very restrictive when spelled out precisely. Based on a critical analysis of existing cases for transcending patient-centeredness we then go on to argue that the medical ethos should indeed contain a rule requiring physicians to alleviate caregiver burden under certain circumstances. Finally, we apply our findings to deep brain stimulation (DBS) for Parkinson's disease. We present empirical data from a recent study of DBS indicating that spousal caregivers of Parkinson patients treated with DBS are sometimes deeply troubled by the effects of the therapy and discuss what moral obligations the treating physicians may have in such cases.     

Death and nurturance in Indian systems of healing

Medically, as in many other ways, India is a pluralistic society. There are numerous different modes of healing in India, which are, as a group, not subject to any form of standardization or centralized control. While such a situation has demonstrable advantages, it may also be legitimate to ask, is medicine in India as fundamentally unordered as it seems? The present paper examines four different healing traditions practiced in Tamil Nadu in southern India. These traditions appear on the surface to be quite diverse, and not to be united into a single, internally consistent medical system. Yet a study of the mythical and philosophical bases of these traditions shows them to share some common premises, and to communicate to the patient or student who attends to all of them a common message concerning the nature of life.     

现代科技革命背景下的中药现代化

中医药在人类疾病的预防和治疗中占有重要地位.21世纪以生命科学、信息科学和物质科学为先导的科学技术正在不断地促进经济的繁荣和人类文化的变革.把它们的研究成果应用于中药的二次开发,加强创新中药的研究,走可持续发展的道路,将极大推动中药现代化的进程.     

Medical ethos and social responsibility in clinical medicine

The medical profession will face many challenges in the new millenium. As medicine looks forward to advances in molecular genetics and the prospect of unprecedented understanding of the causes and cures of human disease, clinicians, scientists, and bioethicists may benefit from reflection on the origins of the medical ethos and its relevance to postmodern medicine. Past distortions of the medical ethos, such as Nazism and the Tuskegee Syphilis Study, as well as more recent experience with the ethical challenges of employer-based, market-driven managed care, provide important lessons as medicine contemplates the future. Racial and ethnic disparities in health status and access to care serve as reminders that the racial doctrines that fostered the horrors of the Holocaust and the Tuskegee Syphilis Study have not been removed completely from contemporary thinking. Inequalities in health status based on race and ethnicity, as well as socioeconomic status, attest to the inescapable reality of racism in America. When viewed against a background of historical distortions and disregard for the traditional tenets of the medical ethos, persistent racial and ethnic disparities in health and the prospect of genetic engineering raise the specter of discrimination because of genotype, a postmodern version of “racist medicine” or of a “new eugenics”. There is a need to balance medicine’s devotion to the well-being of the patient and the primacy of the patient-physician relationship against the need to meet the health care needs of society. The challenge facing the medical profession in the new millennium is to establish an equilibrium between the responsibility to ensure quality health care for the individual patient while effecting societal changes to achieve “health for all”.     

Caveat emptor or blissful ignorance? Patients and the consumerist ethos

The notion that consumerist behaviour is, or should be, prevalent amongst individuals seeking health care has underlain recent United States and British governmental policy directives. Consumer groups make similar assumptions when exhorting individuals to treat health care like any other service. This paper enquires to what extent patients conceive of themselves and others as adopting consumerist behaviour when seeking and evaluating primary health care. Three hundred and thirty-three patients attending general practices in Sydney, Australia, were asked in open-ended questions to state why they chose their regular doctor, why they continued to visit that doctor, if they had ever changed their doctor, if they thought most people could tell if a doctor were good or bad, and what qualities they thought constituted a good and bad doctor. It is concluded that the patients surveyed tended not to think of themselves as consumers who should be wary of the quality of service offered by doctors. Rather they preferred to trust their doctor, and therefore did not devote effort to actively seeking out information about their doctor or evaluating his or her services.     

Traditional healing in South Africa: ethical implications for social work

Within health-care settings, culturally competent practice presupposes an understanding of the socio-cultural meanings attached to illness and disability and the people who are likely to be consulted with respect to providing health care and restoring well-being. Large numbers of South Africans are known to consult with traditional healers in preference to or in conjunction with western, allopathic health-care professionals. The present study represents a secondary analysis of data from various studies conducted on Black African, Muslim, Hindu and Chinese traditional healing systems in South Africa. Common themes that emerged from the analysis included the attribution of illnesses and disorders to spiritual factors, punishment and superstitious beliefs. Treatment approaches included the use of natural substances, prayer and rituals, and procedures that were designed to restore equilibrium. The participants also articulated their views on medical pluralism, collaboration between western and traditional health-care practitioners, and reasons why people consulted with traditional healers. The findings are discussed in terms of their ethical implications for social work.     

加强行风建设 构建和谐医院

行风建设的好坏,直接关系到和谐医院的创建。本文分析了当前医院行风中存在的主要问题,探讨了如何从加强医患沟通、改进服务流程、加强药品和高值耗材管理、畅通投诉渠道、加强制度建设、加大宣传力度等方面来改进医院行风建设的现状。     

Identification and validation of factors used to evaluate science course delivery systems

Deans and faculty from seven academic-health-center-based colleges of allied health participated in a three-round modified Delphi study to identify and validate factors that can be used to evaluate administrative aspects of science course delivery for baccalaureate allied health students in these settings. Factors identified accommodate different organizational structures and apply across programs and science disciplines. Participants identified several science faculty qualifications and roles expected of science faculty, allied health faculty who do not teach sciences, and deans. There was less consensus and fewer expectations on the role of the science faculty when appointment and course sponsorship were external to the college. The findings from this study, which was structured around an interdisciplinary professional education framework, have practical and research relevance for allied health.     

从循证公共卫生看流行病学研究证据生产现状

  目的  以Cochrane系统评价为例,分析公共卫生领域高级别证据的流行病学和描述性特征,为公共卫生循证决策提供参考依据。  方法  于2018年4月30日检索Cochrane library数据库收集公共卫生领域相关的Cochrane系统评价,应用EndNote X7、Excel 2013和Ucinet 6.0软件对纳入的文献进行筛选管理和数据分析。  结果  初检获得112篇文献,依据纳入排除标准筛选最终纳入69篇文献,其中高质量33篇、中等质量34篇;发表年份为2008 — 2018年,其中2010年发表文献最多（14篇,20.3 %）,2014年发表文献最少（2篇,2.9 %）;通讯作者主要来自英国（28篇,40.6 %）、澳大利亚（12篇,17.4 %）和美国（9篇,13.0 %）,仅5名中国学者以合作者身份参与研究;研究主题以“预防伤害”（22篇,31.9 %）和 “预防道路交通伤害”（18篇,26.1 %）为主;纳入研究设计主要包括随机对照试验（58篇,84.1 %）、临床对照试验/非随机和半随机对照试验（26篇,37.7 %）、前后对照试验（32篇,46.4 %）和间断地时间序列研究（19篇,27.5 %）;关键词社会网络图显示,“Intervention”、“Prevention”、“Program”、“Injury”、“Education”、“Children”、“Worker”、“Adults”均位于网络的核心位置,是公共卫生领域的研究热点。  结论  公共卫生研究领域中Cochrane系统评价以中国学者作为第一作者或通讯作者发表的研究甚少,纳入的研究主要关注伤害与道路交通伤害的预防。