The life mission theory: a theory for a consciousness-based medicine

Genetic factors, external stress and the human factor are influential to the health and well-being of every person. Several studies have shown that the human being have many internal powers that can promote health and increase quality of life. A theory on the human meaning of life is put forward and how it relates to health, disease and quality of life in the context of holistic medicine.     

防御性医疗与医疗免责

分析了防御性医疗行为产生的原因和特点,结合医疗免责的原则与标准,探讨建立医疗免责与减少防御性医疗行为的重要意义。     

Quality management in Australian emergency medicine: translation of theory into practice.

OBJECTIVES: The primary objective was to describe the current level of implementation of quality management (QM) structures and practices with Australian emergency departments. The secondary objective was to describe the level of association between the presence of QM structures and processes and the achievement of associated improvements. DESIGN: Data were collected by mail-out of a structured survey instrument to all Australian emergency departments accredited for postgraduate training by the Australasian College for Emergency Medicine. PARTICIPANTS: Director of Emergency Medicine or delegate in each surveyed department. MAIN OUTCOME MEASURES: The presence of specific structure and process indicators of QM and the achievement of QM linked improvements. RESULTS: A response rate of 63% was achieved. Designation of a hospital quality improvement (QI) physician was reported by 40% of institutions, an emergency department (ED) QI physician by 40%, and an ED QI nurse by 67%. A structured system for QM indicator analysis was present in 67% of the departments; in 45% of the departments public reporting of performance occurred. There was a significant association between QM process indicators and the presence of (i) a hospital QI physician (P=0.02), (ii) an ED QI nurse (P=0.02), (iii) presence of a system for data analysis and reporting (P=0.01), and (iv) presence of a QM component to postgraduate education (P= 0.05). There was a significant relationship between the presence of QM process indicators and the achievement of QM linked improvements (P= 0.003). CONCLUSIONS: Demonstration of the links between QM structures, its indicators of activity (in structure and process), and the achievement of outcome improvement is fundamental to quality improvement methodology. These links are demonstrated within the context of Australian emergency medicine, providing support for the effectiveness of this approach in promoting change and performance improvement.     

Evidence-based medicine: putting theory into practice

Evidence-based medicine is an essential tool to ensure the effective and efficient management of patients. A practical and unbiased assessment of clinical evidence can be achieved by asking simple questions about the data. Undertaking this process can reveal a new perspective on traditional treatment approaches.     

医学化学理论教学的延伸和拓展

医学研究工作已逐渐进入分子水平,促使化学与生物和医学的联系更加紧密.正是基于这样的原因,化学的教学改革就显得特别重要,也势在必行.化学教学应在重视基础同时,加强与其它基础学科和临床学科的联系.     

Inpatient resource use: a comparison of family medicine and internal medicine physicians.

BACKGROUND. It is not known whether differences exist between the use of inpatient resources by family medicine and internal medicine physicians when patient demographic and complexity variables are statistically controlled. METHODS. The study population was all patients in 13 higher volume diagnosis-related groups (DRGs) discharged from the family medicine (n = 306) and internal medicine services (n = 2374) of the University of Cincinnati Hospital during 1985 and 1986. The dependent variables were length of stay and inpatient readmission within 2 weeks. Stratification by DRGs was used to control for the effects of age and case mix on these variables. RESULTS. With the exception of findings regarding one DRG, the results do not indicate that differences exist in average length of stay between patients of family medicine and internal medicine physicians after adjustment for other variables. Furthermore, almost all of the explained variance in length of stay was attributed to patient complexity and not to physician specialty or patient race or sex. For all discharges, the proportion of patients readmitted within 2 weeks was about 4% higher for the internal medicine service. However, multivariate analysis did not support the importance of physician specialty (family medicine or internal medicine) as a predictor of whether readmission occurred within 2 weeks. CONCLUSIONS. General indicators of resource use (such as length of stay or readmission occurrence) without adjustment for patient case mix, demographics, and complexity are inadequate for comparison of health care providers. Further research regarding interspecialty differences should use longitudinal data from large populations, which would permit more detailed examination of resource utilization.     

Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part one

Evidence-based medicine (EBM) is an indispensable tool in clinical practice. Teaching and training of EBM to trainee clinicians is patchy and fragmented at its best. Clinically integrated teaching of EBM is more likely to bring about changes in skills, attitudes and behaviour. Provision of evidence-based health care is the most ethical way to practice, as it integrates up-to-date, patient-oriented research into the clinical decision making process, thus improving patients' outcomes. In this article, we aim to dispel the myth that EBM is an academic and statistical exercise removed from practice by providing practical tips for teaching the minimum skills required to ask questions and critically identify and appraise the evidence and presenting an approach to teaching EBM within the existing clinical and educational training infrastructure.     

PET设备的成像原理、现状及展望

目的:正电子发射计算机断层扫描是核医学发展的一项新技术,阐述PET成像原理、发展动态、存在的问题以及发展趋势.方法:从PET的定义开始,介绍原理,临床应用,优缺点和发展动态.结果:PET在心、脑、肿瘤等器官的功能、血流和代谢情况的分析和早期诊断方面具有广泛的应用前景.结论:PET的发展推动了影像医学和临床医学的整体发展,PET/MRI和PET/CT复合系统的应用将核医学影像引向一个新的领域,必将对人类的健康发挥重要的作用.     

Applications of narrative theory and therapy to the practice of family medicine

This article presents narrative theory and therapy as an approach with significant potential for providing family physicians with additional tools to assist them in dealing with difficult clinician-patient encounters. We first define narrative therapy, then briefly describe its theoretical assumptions in relation to psychosocial concepts already familiar to family physicians. Important aspects of narrative therapy are examined, including the unique role of questioning in the narrative process; understanding and helping patients change their problem-saturated stories; renaming and externalizing the patient problem; and the use of rituals, documents, and audience in recognizing and reinforcing patient change. The article concludes with thoughts about how narrative approaches can contribute to more-healing doctor-patient relationships.     

计划行为理论及其在医学中的研究应用

计划行为理论(theory of planned behavior,TPB)是在理性行为理论的基础上发展与延伸出来的一种社会认知理论。近来该理论广受社会行为研究者的青睐,已成功的在多个行为领域中应用。本文主要介绍计划行为理论的起源与发展、主要内容以及医学中的应用现状,并分析其应用前景。