运用循证医学构建和谐医患关系

介绍医患关系现状,阐述医疗实践中医患双方关系的对立与统一。提出在医学模式转换时期,运用循证医学改善医患关系的必要性,呼吁医务人员要积极学习和自觉应用循证医学构建和谐医患关系。     

Doctor-Patient Relationship in Cystic Fibrosis - a Patient's Perspective

Cystic fibrosis (CF) is a complex chronic disorder of young people who will depend on medical care for the rest of their lives. A good doctor-patient relationship is vital to their wellbeing, but can be subject to conflict of independence, conflict between life style and need for medical care, conflict between doctor and patients' interests and conflict of knowledge between a patient and doctor. A successful relationship based on holistic approach is essential to the treatment of CF.     

从循证医学角度构建和谐医患关系

分析当前医患关系的紧张状况及其原因,提出循证医学能为深化医疗体制改革、完善社会保障制度提供科学依据;为医患双方提供充分的信息,提高医疗质量,减轻患者医疗费用负担;以患者为中心构建和谐医患关系。     

医学本科生医患沟通教育满意度调查

目的了解医学本科教育阶段医患沟通教育现状,同时分析医学本科生对沟通能力培养现状的满意度及其影响因素,为促进医学本科生临床沟通能力培养提供参考。方法采取方便抽样的方法,抽取50％的四川大学华西临床医学院2006～2009级临床医学专业的在校本科生作为调查对象,采取面对面访谈的方式,以自制问卷进行调查,采用EpiData3．0软件录入数据,并用SPSS13．0软件统计分析。结果发放问卷450份,回收有效问卷404份,有效回收率89．78％。结果显示：74．3％的受访者对当前医患沟通教育现状比较满意,75．7％的受访者表示自己在基础知识学习阶段开始接触医患沟通教育,49．8％受访者所在专业采用PBL教学,65．5％的受访者所在专业年级引进标准化病人（SP）进行辅助教学。年级、性别、是否开设sP辅助教学、是否开设PBL课程是影响医学生对医患沟通教育现状满意度的主要因素（其P值分别为0．029、0．023、0．012、0．029）。结论医学本科生对当前本科阶段医患沟通教育现状整体满意度较高,满意度受多种因素影响。医学本科生沟通教育起步较早,但培养体系并不完善,教学资源覆盖有限。现行医学院校应该开设医患沟通教育整合课程,结合PBL教学模式和SP辅助教学,深入到整个本科学习阶段,系统、规范、全面培养医学生临床交流的认知和实践能力。     

妇科内分泌专家门诊医患交流质量的现状调查

目的了解妇科内分泌专家门诊医患交流中的情况及问题,以便改进工作,提高诊疗质量。方法采用自编《妇科内分泌专家门诊的医患交流质量评估表》对2010年4～8月期间在四川大学华西第二医院妇科内分泌专家韩字研教授门诊就诊的403例女性患者进行调查。结果患者提供病史和接受诊疗信息的情况:通过医生询问病史,只有29%(118/403)和38%(152/403)的患者能准确提供既往治疗史和检查情况。当医生向患者交代本次检查情况及治疗意见后,仅21%(86/403)的患者能准确理解检查结果,27%(108/403)的患者能准确理解处理和治疗意见。相关性分析显示,患者提供病史和接受诊疗信息的准确性在21～40岁年龄组高于≤20岁年龄组,初中及以上文化程度组高于小学组,非医护患者组低于医护患者组,差异均有统计学意义(P值均<0.05)。患者就诊态度:医患交流中,有55%(222/403)的患者希望得到医生更多关注,37.5%(151/403)的患者对医疗的期望值过高。结论在妇科内分泌专家门诊,大多数患者因受年龄、文化程度和职业影响,不能准确提供既往检查和治疗史,也不能准确理解本次检查情况和治疗意见,另外,患者的心理需求值得关注。     

The Relationship of Violence and Trichotillomania

Purpose: To examine the relationship between violence and the development of trichotillomania (TTM) in women.
Design and methods: Semistructured interviews were conducted with a convenience sample of 44 women with trichotillomania from 21 American states and Canada. The participants were asked to describe how they live and cope with TTM. The data were subjected to content analysis and were quantified for presentation. Checks were instituted to establish reliability of the content analysis using the criteria of reproducibility and stability.
Findings: Forty of the 44 women (91%) reported some form of trauma or violence occurring during their lives and 38 (86%) reported a history of violence concurrent with the onset of TTM. Events ranged from repetitive and moderate to severe abuse (including sexual assault, rape, and gang rape) by family members, acquaintances, and strangers.
Conclusions: These women with trichotillomania experienced a disproportionate number of traumatic or violent episodes in childhood. In most cases, the onset of TTM was correlated with specific episodes of violence. Of special interest is the possible relationship between family chaos experienced during childhood and the onset of TTM.     

高胰岛素血症与动脉粥样硬化

Reavens于1988年首次提出了胰岛素抵抗综合征（IRS）的概念，认为胰岛素抵抗是诸多致动脉粥样硬化危险因素的基本原因，最终导致动脉粥样硬化的形成和发展。高胰岛素血症是胰岛素抵抗的一种代偿表现或治疗后表现，往往与心血管疾病的危险因素     

The Father-Infant Relationship: Becoming Connected

purpose . To explore fathers' experiences of developing a relationship with their infants during the infant's first 2 months of life
design . Grounded theory approach
setting . Fathers' homes or other mutually agreed-upon site
participants . First-time fathers (N = 14), ages 28–44, Caucasian, middle class
main outcome measures . Tape-recorded semistructured interviews to elicit fathers' perceptions of their fathering selves, their infants, and the father-infant relationship.
results . Using constant comparative method for analysis, three major categories were identified as operative in the initial development of the father-infant relationship: (a) making a commitment, (b) becoming connected, and (c) making room for the baby.
conclusions . With an increased understanding of the father-infant relationship, nurses can provide humanistic, thoughtful care to assist fathers in developing this significant relationship.     

The Patient-Provider Relationship in Chronic Pain

The relationship between patient and provider has long been the subject of study within the psychotherapy literature, with the available data suggesting a modest, but reliable, association between the strength of this relationship and treatment outcome. Conversely, there has been little work focused on the patient–provider relationship in chronic pain settings despite the complexities and difficulties that are often involved in this area. This review provides a brief, broad overview of the literature on the patient–provider relationship and identifies key aspects that are specifically relevant to chronic pain settings. In addition to reviewing the literature in this area, a series of recommendations for future clinical and academic work are offered.     

内皮素与高血压

自从 Ｍｏｎｃａｄａ Ｖａｎｅ发现血管内皮细胞能释放前列环素（ＰＧＩ２）调节血管紧张性以后,人们非常重视血管壁产生的血管活性物质。 １９８０年 Ｆｕｒｃｈｇｏｔｔ等又发现了内皮源性松驰因子（ＥＤＲＦ）,因此,人们对于内皮参与血管紧张性的调节产生了浓厚的兴趣。有证据表明内皮除与血管扩张外还与血管收缩有关,如去甲肾上腺素。凝血酶、花生四烯酸等引起血管收缩,完整内皮能加强这些因素的缩血管作用,有些因素甚至必须依赖内皮才能发挥作用,提示内皮在各种因素的的刺激下可以释放出血管收缩性物质。 １９８８年日本学者Ｙ…     

The Relationship Between Headaches and Sleep Disturbances

The relationship between headaches and sleep disturbances is complex and difficult to analyze. Both symptoms may have casual relations, or may be associated in the same patient with mutual reinforcements.
We studied 25 patients presenting with morning or nocturnal headaches. Standard headache diagnosis and polysomnography were performed. After polysomnography, the diagnoses were reevaluated.
The main headache entities were cluster, chronic paroxysmal hemicrania, migraine, tension, combined headache, and chronic substance abuse headache.
For each group, headache, sleep data, and changes in diagnosis are discussed. The diagnosis was changed in 13 patients; the final diagnoses were periodic movements of sleep, fibromyalgia syndrome, and obstructive sleep apnea. The diagnoses of cluster headache and chronic paroxysmal hemi-crania were not modified by polysomnography.
The migraine and tension headache groups had a relative male preponderance, and the diagnosis was changed in approximately half of the patients. This was also observed in combined headaches. Patients who had chronic substance abuse headaches had mainly insomnia, which in some cases, was relieved by stopping medication.
Data were also analyzed in terms of simple models linking headache and sleep disturbances. Such an approach allowed the identification of several modes of mutual interaction.
In summary, morning or nocturnal headaches are frequent indicators of a sleep disturbance and their presence might justify polysomnography, and the use of simple clinical models may be useful for understanding the complex relationship between headache and sleep.