超声观察节育器的局限性

目的探讨超声在宫内节育器观察上的局限性。方法病人需适度充盈膀胱,平卧于检查床上,行下腹部超声检查。结果超声在宫腔钙化、宫腔积气时有时误诊为节育器;对部分节育器的形态不能明确诊断;对节育器游离于腹腔的无法诊断。结论超声是节育器检查的最常见的、最有效的方法,但在某些方面有一定的局限性。     

医学影像诊断工作中的哲学思维

医学影像诊断是临床疾病诊疗的重要辅助手段之一,在诊断过程中疾病通常以静态的方式展现,是影像诊断的特点之一。然而在疾病静态反映下会产生某些局限性,在某种程度上导致医学人文的缺失,如何正确运用哲学思维认识、分析及解决问题,对影像诊断医生来说至关重要。在影像诊断中强化哲学思维,就是要坚持“以患者为中心”的医学观,坚持综合性、规律性和能动性的统一。这不仅能有效训练影像诊断医生的诊断思路,同时也能提高其人文素质,解决这些局限所带来的有关问题,从而使诊断结果既有技术的精准又有情感的温度。     

Suicide prevention by limiting access to methods: A review of theory and practice

This review discusses the limitation of access to suicide methods as a way to prevent suicide, an approach which forms a major component of many national suicide prevention strategies. An important distinction is made between efforts that attempt to limit physical access to suicide methods and those that attempt to reduce the cognitive availability of suicide. Physical imitations will be reviewed with reference to restricting access to domestic gas, catalytic converters, firearms, pesticides, jumping, paracetamol and methods used in prisons. Impacts of cognitive availability will be discussed mainly with regard to the media in terms of providing access to technical information and sensational or inaccurate portrayals of suicide. Drawing on psychological models of suicidal ideation and behaviour, this review explores how processes leading to suicidal behaviour and issues around method choice may relate to the effectiveness of limiting access to methods. Potential problems surrounding method limitations are explored, in particular the factors contributing to substitution, the risk that alternative methods of suicide may be used if one is restricted. It is concluded that in appropriate contexts, where substitution is less likely to occur, and in conjunction with psychosocial prevention efforts, limitation of both physical and cognitive access to suicide can be an effective suicide prevention strategy.     

不同体位经肛门内镜微创治疗局限性直肠肿瘤的手术配合护理研究

目的探讨不同体位在经肛门内镜微创治疗局限性直肠肿瘤的手术配合护理方法。方法将120例直肠肿瘤患者按数字随机法分为观察组和对照组,每组患者各60例。观察组术前抬高左下肢1 min后再抬高右下肢,术后亦平放左下肢1 min后再平放右下肢。对照组术前和术后均后同时抬高和平放双下肢。两组患者均采取常规护理,比较患者术后疼痛、患者满意度和血流动力学。结果观察组疼痛评分得分在5分以下的患者比例高于对照组,疼痛评分得分在5分以上的患者比例则低于对照组,差异有统计学意义（P〈0.01）。观察组患者满意度为80.00%,显著高于对照组（56.67%,χ2=6.87,P〈0.01）。术后观察组患者的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）等血流动力学水平控制均优于对照组（P〈0.05）。结论采用单侧下肢截石位配合护理可更有效地减轻局限性直肠肿瘤患者经肛门内镜微创手术疼痛,提高患者满意度和控制血流动力学水平,值得临床推广使用。     

New end of life's approach: law of April 22, 2005 and decrees of February 6, 2006

Further to a national debate, extremely mediatized, the law of April 22, 2005 relating to the rights of the patients and the end of life, was adopted. This law brings new rights to the patients and clarifies the medical practice concerning situations of end of life. Physicians have to refrain from any unreasonable stubbornness in investigations or therapeutics and they can give up beginning or pursue treatments which seem useless, disproportionate or which have the other object or effect than the artificial preservation of the life. Pain's relief is a right of the patient. Physicians can, with the aim of relieving the suffering of a end of life's person, give a treatment being able to have the effect secondary to abbreviate life. The patient can draft early directives. Decision of limitation or stop a treatment concerning a person who can't express its will, has to take into account the wishes, which the patient would have before expressed through early directives and\or by consulting the person of trust, as well as the family. Stop or limitation of a treatment concerning a person incapable to express its will can not be realized without respecting a collective procedure.     

Gender gaps in life expectancy and expected years with activity limitations at age 50 in the European Union: associations with macro-level structural indicators

Women generally live longer than men, but women’s longer lives are not necessarily healthy lives. The aim of this article is to describe the pattern of gender differences in expected years with and without activity limitations across 25 EU countries and to explore the association between gender differences and macro-level factors. We applied to the Eurostat life table’s data from the Statistics of Income and Living Conditions Survey to estimate gender differences in life expectancy with and without activity limitations at age 50 for 2005. We studied the relationship between the gender differences and structural indicators using meta-regression techniques. Differences in years with activity limitations between genders were associated with the life expectancy (LE) and the size of the gender difference in LE. Gender difference in years with activity limitations were larger as the gross domestic product, the expenditure on elderly care and the indicator of life-long learning decreased, and as the inequality in income distribution increased. There was evidence of disparity in the associations between the more established EU countries (EU15) and the newer EU10 countries. Among the EU15, gender differences were positively associated with income inequality, the proportion of the population with a low education and the men’s mean exit age from labour force. Among the EU10, inequalities were smaller with increasing expenditure in elderly care, with decreasing poverty risk and with decreasing employment rate of older people. The association between structural indicators and the gender gap in years with activity limitations suggests that gender differences can be reduced.     

达尔文理论的历史和科学的局限性

19世纪中叶英国博物学家达尔文提出了生物进化论。达尔文进化论是迄今被普遍视为证据最为充分的科学理论之一,也是对地球上丰富多彩的生命形式的唯一解释。然而,达尔文进化论作为一种理论,仍随着新证据的出现不断受到检验,并且在理论中尚存在未得到证据支持的空白。着重分析达尔文理论产生的时代局限性,主要是当时哲学和科学的局限性,说明在科学不断发展的条件下,达尔文主义不是终极的进化理论。而140年来,种种新达尔文主义理论也并没有突破工业时代的物质科学和物质哲学的束缚。因此,推出具有信息时代特征的生物进化理论和包括无机界与人类社会的广义进化理论,是当代学者的重要使命。     

浅析病历缺陷引起的医疗纠纷

目的分析病历缺陷引起医疗纠纷的情况及现实意义。方法通过医院及有关报道实际材料。结果医院败诉,造成名誉及经济损失。结论规范化书写病历的重要性。