我国医患共同决策的研究现状

医疗环境的改变,全民健康需求的多样化要求我们对传统诊疗模式做出调整和完善。本文从医患共同决策在我国大陆地区的临床研究现状及存在问题两方面进行综述,旨在为临床研究的实施和诊疗模式改进提供参考。     

医患冲突引起群体性事件演变机理研究

通过背景、内部动力、外部引爆、关系结构和功能5个方面来分析、研究医患冲突引起群体性事件的演变机理,以期减少及防止医患冲突引起群体性事件的发生,同时对处置此类群体性事件也有着重要的借鉴意义.     

中医OSCE之医病沟通教案设计与执行

客观结构式临床测验（OSCE）是目前医学教育发展的重要项目之一。中医教育发展受到西方医学教育影响,也逐步发展出中医的客观结构式临床测验。医病沟通是极为重要的临床能力,藉由OSCE能够观察并给与教学回馈以建立医学生的医病沟通能力。教案设计中的剧本撰写与标准化病人训练是OSCE的关键要素,以期达到一致且具有效度的评量。     

Effects of anterior tooth crown inclination on occlusal relationship—A study in three-dimensional reconstruction

ObjectiveThis study aims to analyze the relationship between the central incisor crown inclination and occlusal relationship via three-dimensional study.MethodsTen Chinese volunteers with normal occlusion were selected from physical examination of college students. Lateral cephalograms and CT scans were taken, and the CT data were imported into Simplant pro 11.04 to reconstruct three-dimensional model. In the three-dimensional model, every tooth was separated independently. The upper and lower central incisors were moved labial inclination(up) or lingual inclination(down) and then the upper and lower tooth were aligned based on the central incisor’s position according to the principles of Andrew’s six keys. Four groups were set up with different changes of central incisors. The upper and the lower arch were aligned again based on the moved central incisors. After every motion, the mesio-distal distances of upper and lower canines and first molars were recorded. All data were analyzed using t-test via SPSS19.0, and the significance level was set at 5%.ResultsThe results showed that the mesio-distal distances of occlusal relationship were different from normal occlusal relations, when either upper incisor crown inclination or lower incisor crown inclination was changed, and both upper and lower incisor crown inclination were moved in same or opposite direction. According to the statistical analysis, there was no significant difference when the changes of U1-L1 were no more than 10° (P > 0.05). But there was statistically significant difference (P < 0.05) when changes of U1-L1 were more than 20°.ConclusionsThe incisor crown inclination has influence on the establishment of occlusal relationships. The bigger difference upper and lower incisor crown inclination has, the more deviations from the normal occlusal relationship exist.     

In vitro and in vivo correlation for lipid-based formulations: Current status and future perspectives

Lipid-based formulations (LBFs) have demonstrated a great potential in enhancing the oral absorption of poorly water-soluble drugs. However, construction of in vitro and in vivo correlations (IVIVCs) for LBFs is quite challenging, owing to a complex in vivo processing of these formulations. In this paper, we start with a brief introduction on the gastrointestinal digestion of lipid/LBFs and its relation to enhanced oral drug absorption; based on the concept of IVIVCs, the current status of in vitro models to establish IVIVCs for LBFs is reviewed, while future perspectives in this field are discussed. In vitro tests, which facilitate the understanding and prediction of the in vivo performance of solid dosage forms, frequently fail to mimic the in vivo processing of LBFs, leading to inconsistent results. In vitro digestion models, which more closely simulate gastrointestinal physiology, are a more promising option. Despite some successes in IVIVC modeling, the accuracy and consistency of these models are yet to be validated, particularly for human data. A reliable IVIVC model can not only reduce the risk, time, and cost of formulation development but can also contribute to the formulation design and optimization, thus promoting the clinical translation of LBFs.     

Psychoanalytic Intervention with Children

By taking a social psychological approach, this article seeks to offer an alternative perspective to the traditional psychoanalytic studies of Freud and Ferenczi's close personal and professional relationship, and the rift that occurred in the early 1930s. It is suggested that the socially constructed, divergent roles that these two men fulfilled in the psychoanalysis movement deeply influenced the dynamics of their relationship. It is further proposed that the ever-present, conflicted political interdependence that characterized Freud's and Ferenczi's home countries (Austria and Hungary, respectively) may have affected them differently, and contributed to their divergent attitudes towards power and other issues relevant to the development of psychoanalytic theory and technique, as well as how they related to one another personally.     

Dutch youth of parents with a mental illness reflect upon their feelings of guilt and shame

Children of parents with a mental illness (COPMI) have a higher risk of acquiring a mental illness themselves. Feelings of guilt and shame could increase COPMI risks of acquiring mental health disorder symptoms. These feelings of guilt and shame could also impact the quality of the parent-child relationship. Data were drawn from the qualitative part of a mixed method study featuring 18 face-to-face interviews with Dutch COPMI aged 12–21. Interviewees were asked about their experiences with guilt and shame related to their parent with mental illness and the extent they felt that these feelings affected their relationships with their parents. Qualitative thematic analysis (QTA) revealed that most COPMI youth described feelings of guilt and some of them reported feelings of shame. They reported making behavioral adjustments especially using caution in parental communication. In their perception, guilt and shame did not have long-term impacts on their relationships with parents.     

Occupational Therapy Intervention for Residents in a Skilled Nursing Facility: A Focus on Atypical Patients

The 1990 implementation of the Omnibus Budget Reconciliation Act (OBRA) has expanded opportunities for occupational therapists to treat individuals with non-traditional illnesses. Therapists working in skilled nursing and long term care can benefit from gaining an understanding of the OBRA guidelines and patient's rights, especially regarding restraint reduction. Occupational therapists possess the necessary skills to assess and treat these individuals to help maximize their functioning as well as improve their quality of life (Moon-Sperling & Pinson, 1991). The premise of this article is to inform therapists about various types of ethical and legal intervention with atypical patients in skilled nursing facilities and to introduce therapists to the laws supporting provision of these services. [Article copies available for a fee from The Haworth Document Delivery Service: 1–800–342–9678. E-mail address: getinfo@haworth.com]