图书馆员个人职业生涯规划

从图书馆员个人的角度,对图书馆员的职业发展现状和所处的各种环境进行了分析,提出在目前图书馆员职业生涯发展道路比较单一的情况下,图书馆员要调整心态,塑造新的职业观念,以成就感和赢得尊敬为目标。同时还探讨了图书馆员职业生涯规划的相关内容和要求。     

平等问题的哲学思考

一方面,每个人因其最基本的贡献完全平等——每个人一生下来便都同样是缔结、创建社会的一个股东——而应该完全平等地享有基本权利、完全平等地享有人权,可以名之为完全平等原则;另一方面,每个人因其具体贡献的不平等而应享有相应不平等的非基本权利,也就是说,人们所享有的非基本权利的不平等与自己所做出的具体贡献的不平等比例应该完全平等,可以名之为比例平等原则。社会所提供的发展才德、做出贡献、竞争职务和地位以及权力和财富等非基本权利的机会,是全社会每个人的基本权利,是全社会每个人的人权,应该人人完全平等。反之,家庭、天赋、运气等非社会所提供的机会,则是幸运者的个人权利,无论如何不平等,他人都无权干涉;但幸运者利用较多机会所创获的较多权利,却因较多地利用了共同资源社会合作而应补偿给机会较少者以相应权利。这就是机会平等原则。     

对中医师承制研究生学位论文质量的分析

中医师承制研究生教育是将传统师承教育和研究生教育相结合的创新模式,对不断提高中医药人才培养质量,具有重要的意义。因此做好学位论文质量评定工作是加强研究生教育管理,保证和提高研究生质量的重要环节。本文对我院2008、2009两届授予中医师承制博士和硕士研究生学位的学位论文进行了评价与分析。     

An obstructed death and medical ethics.

In this case analysis deception or lying to a dying patient is discussed within the context of different relationships: the relationship between the patient and her family doctor, the relationship between the patient and the surgeon and the relationship between the patient and her family. It is suggested that the principle of veracity is not only a core feature in the patient-doctor relationship but is also fundamentally connected with the basic element of trust between the patient and doctor. The surgeon, in deceiving the patient, even at the request of her husband, betrayed her trust in violating the principle of veracity. The primary responsibility of the surgeon was towards his patient rather than her family. In lying to his patient the surgeon failed to give Mrs Fasper something she needed most: respect for her as a person.     

How to become comfortable talking about sex to your patients.

Dealing with patients' sex-related complaints is uncomfortable for many physicians. It can become more comfortable if the physician learns to apply his or her clinical knowledge of sexuality in combination with specific interpersonal interviewing skills. The level of comfort can be increased if the physician accepts his or her professional limitations in providing therapy and knows what other sources of care are available.     

A question of conscience. Physicians in defense of human rights

The vital role physicians can play in documenting physical and mental abuse of political prisoners, treating and rehabilitating victims, and preventing the punitive use of medicine is exemplified by the actions of three physicians whose stories are told here. Wendy Orr, a South African prison physician, took her complaint about police torture of political detainees to court after her superiors ignored her reports of prisoner abuse. An internationally known Chilean surgeon, Pedro Castillo, has been arrested twice for his work against the human rights violations of his country's military government. Soviet psychiatrist Anatoly Koryagin is reported to be near death after several years' imprisonment for his activities against involuntary psychiatric commitment of dissidents. Nightingale and Stover remind physicians of their obligation to protest the misuse of medical skills and urge support for professional organizations actively engaged in human rights issues.     

Moral diversity among physicians and conscientious refusal of care in the provision of abortion services

Physicians are independent moral agents whose values, like those of nonphysicians, are shaped by personal experience, religious beliefs, family, and lifetime mentors. Most individuals are free to exercise their moral values in the ways that they see fit within the boundaries of legality. Physicians' moral values take on special significance, however, when considering services patients may request but that contradict that physician's moral beliefs, such as termination of pregnancy. In this article I analyze the competing obligations to self and to patient that a conscientiously objecting physician must consider when his or her personal morality affects his or her relationship with the patient. Despite each physician's freedom to choose his or her mode of practice and which services to provide, a physician with a moral viewpoint that would prevent even counseling on certain options should consider practicing in an area of medicine in which the patient's right to full disclosure of options and informed consent is not compromised by the physician's personal moral stance.     

中医师承制研究生培养的实践与体会

传统中医师承培养与研究生教育有机结合,是中医药人才培养的创新模式,我院经过4年来培养中医师承制研究生的创新实践,遵循中医药人才成长的规律,确立了培养目标,规范了培养过程,建立了全程多元的质量评价机制,为深入开展中医师承制研究生培养工作奠定了基础。     

电子病历在随访及科研中的应用

复旦大学附属肿瘤医院利用电子病历系统。为每个门诊和住院病人建立统一标识，病人历次就诊和住院的电子病历均被关联该标识。实现了病人随访信息的自动登记。并建立科研病史。通过结构化病历实现了科研信息的收集与检索。     

Confidentiality and Huntington's chorea.

A doctor has duties towards his patients of both confidentiality and veracity and at times these may conflict, as in the following case. A mother who has the symptoms of Huntington's chorea does not wish her daughters to know. The doctor must try to make her realise how valuable the information can be to the daughters, and thus obtain her consent to inform them. If the mother's consent cannot be obtained, then the doctor must tell the mother that he cannot allow her attitude to deprive the daughters of this information, especially at this crucial time as they plan to have children. The well-being of the daughters' future families must take precedence over the mother's desire for secrecy regarding her condition.     

How I was almost aborted: reflections on a prenatal brush with death.

After recently meeting with his biological parents, the author--a 29-year-old-married male--learned he had been an hour away from being aborted, being 'saved' only by extraordinary circumstances. In the paper the author reflects upon previous strong pro-choice beliefs and reasserts his commitment to a pro-choice philosophy, integrating his new personal experience. The paper pays particular attention to the biological mother's experience and how her fresh insights have reinforced the author's views on abortion.     

浅析医院内“弃儿”现象与对策

医院内的“弃儿”现象系指患儿亲生父母长期将病残儿滞留在医院,不愿承担医药费用且擅自与治疗病儿的医院失去联系的行为。这种现象既有与社会上“弃儿”相同的因素,也有其特殊因素。此现象虽为数不多,但从医疗改革和社会改革发展的总趋势来看,应提请政府有关部门和社会各界的高度重视和关注,并提供可行的对策,制定出相应的法律、法规,以维护医院的正常医疗工作秩序和合法的经济利益,使我国的儿童医疗保障制度不断改进和完善。     

Parkinson disease of ranking lawyer and legislator SJV Chelvanayakam: a hypothesis

SJV Chelvanayakam (1898-1977), a ranking civil lawyer and legislator, was probably the well known Parkinson disease victim in the 20th century Sri Lanka. He was born in Ipoh, Malaya, where his father had moved in the last decade of the 19th century for professional advancement. Ipoh was then an attractive location for migrants from China and the Indian subcontinent since it was in the Kinta valley--touted then, as the world's richest single tin field. Chelvanayakam was brought to Jaffna peninsula when he was aged four (in 1902 or 1903) by his mother, who returned to her native Tellipalai town partly due to indifferent health during her stay in Kinta region. In this communication, I present a hypothesis that organotin exposure as a foetus or during infancy at his place of birth is likely to have been a contributing factor to Chelvanayakam's Parkinsonism. It seems to fit the available circumstantial evidence.     

Attempted homicide in hospital

Strychnine poisoning is reported in a patient who was the victim of attempted homicide in his home and in a General hospital. The diagnosis proved to be an elusive one over five months. The question of a primary psychiatric diagnosis, raised by the patient’s wife proved to be an attempt by her to cover her crime. Medico-legal issues relating to the management of attempted homicide in hospital are discussed.     

Clinical decision making: from theory to practice. The individual vs society. Is there a conflict?

Eddy argues that many medical interventions that make sense from the point of view of the individual patient and his or her physician might not make sense from the point of view of society -- either because they restrict resources available for other needs, or because they drive up the cost of resources. He illustrates his argument with the case of a hypothetical patient with metastatic breast cancer whose physician offers her an expensive investigative treatment that is 5% effective. The cost of the treatment would buy 10 years of mammogram screening for 150 women. Eddy discusses the nature of the conflict between individuals and society when making judgments regarding the value of different health care activities. He will discuss the resolution of the conflict in a future JAMA article.     

Psychiatric Patients Tracking Through a Private Social Network for Relatives: Development and Pilot Study

The treatment of psychiatric patients requires different health care from that of patients from other medical specialties. In particular, in the case of Department of Psychiatry from the Zamora Hospital (Spain), the period of time which patients require institutionalized care is a tiny part of their treatment. A large part of health care provided to the patient is aimed at his/her rehabilitation and social integration through day-care centres, supervised flats or activities. Conversely, several reports reveal that approximately 50 % of Internet users use the network as a source of health information, which has led to the emergence of virtual communities where patients, relatives or health professionals share their knowledge concerning an illness, health problem or specific health condition. In this context, we have identified that the relatives have a lack of information regarding the daily activities of patients under psychiatric treatment. The social networks or the virtual communities regarding health problems do not provide a private space where relatives can follow the patient’s progress, despite being in different places. The goal of the study was to use technologies to develop a private social network for being used by severe mental patients (mainly schizophrenic patients). SocialNet is a pioneer social network in the health sector because it provides a social interaction context restricted to persons authorized by the patient or his/her legal guardian in such a way that they can track his/her daily activity. Each patient has a private area only accessible to authorized persons and their caregivers, where they can share pictures, videos or texts regarding his/her progress. A preliminary study of usability of the system has been made for increasing the usefulness and usability of SocialNet. SocialNet is the first system for promoting personal interactions among formal caregivers, family, close friends and patient, promoting the recovery of schizophrenic patients. Future studies should study the network’s potential usefulness for improving the prognosis and recovery of schizophrenia.     

Woman wants dead fiancé's baby: who owns a dead man's sperm

The Brisbane Supreme Court has denied an Australian woman's request to harvest and freeze her dead fiancé's sperm for future impregnation. After she was denied access to the sperm, the woman learnt that her fiancé may have been a sperm donor and she began checking to find out if his sperm was still available. Given what we know, there is a good ethical argument that the woman should have access to the sperm and should be allowed to have her dead fiancé's child. Another aspect of this case is that it illustrates the way in which ethics, law, and personal opinion can differ.     

Case conference. Fain would I change that note.

The recording and transmission of medical information poses many problems. The patient generally rarely sees his or her notes and possibly gives little thought to how or what is recorded, trusting that the doctor 'knows best' and will be noting, in a professional manner, that which will be useful for the diagnosis. In two cases presented, one of the patients sees her notes and is very upset by what she reads, the other requests that certain information be deleted from her case record. The actions of the doctors and patients were discussed in a preliminary conference at a recent postgraduate meeting. All the names in this Case conference have been changed.     

上海市医师专科培训的可行性调查和策略研究

本课题调查了上海市12所医院的1328名管理者与临床医师,了解他们对上海市开展临床医师专科培训方案的认识及建议。调查发现,有95.0％的被调查者认为上海有必要推行临床医师专科培训,65.2％的被调查者认为目前住院医师规范化培训不能完全适应专科培训的需要。作者认为今后上海临床医师专科培训的框架可构筑在原住院医师规范化培训的基础上,强化第二阶段的培训,更突出专科培训的特点,临床医师只有接受专科/亚专科培训后方能就职;进行临床医师专科培训的医院或科室应有专门机构的认定;在临床医师专科培训管理中,卫生行政部门、医学会和医院应各尽其职,使临床医师的专科培训、使用、考核成为一体。     

The physician as an accessory in the parental project of HIV positive people

The question of the moral acceptability of infertility treatment to HIV positive persons raises a number of interesting ethical points regarding the responsibility of the infertility specialist for the outcome of his or her actions. The analysis of the physician's responsibility is conducted within the framework of accomplice liability. The physician is a collaborator in the parental project of the principals--that is, the intentional parents. Both causal contribution and intention are considered as elements of complicity. It is concluded that a two per cent risk of vertical transmission when the woman is HIV positive is insufficient to blame the infertility specialist who helps her to conceive. Helping an infertile HIV positive infertile couple to have a child does not constitute reckless behaviour. When the couple is fertile, infertility treatment is directed at risk reduction and falls under the physician's obligation to act in the best interests of his patients.