医学院校卫生法学教学的现实困境及优化策略探讨

卫生法学作为医学人文学科的重要课程,在医学院校的课程体系中越来越受到重视。但由于我国卫生法学教育起步较晚,无论是课程的设置、教材的建设还是师资的培养都存在诸多问题。该研究从卫生法学教学的现状和问题入手,提出优化和改革策略,以期为高校的卫生法学教学提供依据。     

Unprofessional practice and student professionalism dilemmas: What can radiography learn from the other health professions?

ObjectiveProfessionalism in radiography is a complex, multidimensional concept seldom investigated. During clinical placements, students may observe or be involved in unprofessional practice/professionalism lapses which result in professionalism dilemmas. Establishing what constitutes a professionalism dilemma and what action to take may be challenging for students and also practitioners. This is due to unclear reporting pathways and fear of retribution, both deterrents to raising concerns. The aim of this integrative literature review was to investigate how and why professionalism dilemmas occur. In addition, to explore the types of dilemma students experience during clinical placement and to contextualise and reflect on these findings within radiography. Ovid MEDLINE, PubMed, Google Scholar and the grey literature were reviewed, analysed and themed.Key findingsTwenty-eight papers (published between 2004 and 2020) were analysed and summarised. Four themes emerged, and were discussed within the radiography context; the nature of professionalism lapses (mistreatment, verbal abuse, exclusion and intimidation), reasons for professionalism lapses (burnout and poor role modelling), student response at the time of the professionalism dilemma (accept, resist or report) and long-term impacts on students (moral/emotional distress, professional development and choice of career).ConclusionProfessionalism dilemmas are not reported in the radiography literature but are cited in radiology and other health professions studies. Student experiences of such dilemmas can be profound and long lasting. Thus, research is required to investigate specifically the professional dilemmas experienced by radiography students in the unique environment in which they develop their clinical skills.Implications for practiceThe literature review findings can be used to support the development of strategies to enhance future teaching and modelling of professionalism and develop related research in radiography.     

Collapse of cooperation in evolving games

Game theory provides a quantitative framework for analyzing the behavior of rational agents. The Iterated Prisoner’s Dilemma in particular has become a standard model for studying cooperation and cheating, with cooperation often emerging as a robust outcome in evolving populations. Here we extend evolutionary game theory by allowing players’ payoffs as well as their strategies to evolve in response to selection on heritable mutations. In nature, many organisms engage in mutually beneficial interactions and individuals may seek to change the ratio of risk to reward for cooperation by altering the resources they commit to cooperative interactions. To study this, we construct a general framework for the coevolution of strategies and payoffs in arbitrary iterated games. We show that, when there is a tradeoff between the benefits and costs of cooperation, coevolution often leads to a dramatic loss of cooperation in the Iterated Prisoner’s Dilemma. The collapse of cooperation is so extreme that the average payoff in a population can decline even as the potential reward for mutual cooperation increases. Depending upon the form of tradeoffs, evolution may even move away from the Iterated Prisoner’s Dilemma game altogether. Our work offers a new perspective on the Prisoner’s Dilemma and its predictions for cooperation in natural populations; and it provides a general framework to understand the coevolution of strategies and payoffs in iterated interactions.Iterated games provide a framework for studying social interactions (1–6) that allows researchers to address pervasive biological problems such as the evolution of cooperation and cheating (2, 7–12). Simple examples such as the Iterated Prisoner’s Dilemma, Snowdrift, and Stag Hunt games (13–18) showcase a startling array of counterintuitive social behaviors, especially when studied in a population replicating under natural selection (16, 19–25). Despite the subject’s long history, a systematic treatment of all evolutionary robust cooperative outcomes for even the simple Iterated Prisoner’s Dilemma has only recently emerged (21, 26–29).Understanding the evolution of strategies in a population under fixed payoffs already poses a steep challenge. To complicate matters further, in many biological settings the payoffs themselves may also depend on the genotypes of the players. Changes to the payoff matrix have been studied in a number of contexts, including one-shot two-player games (13), payoff evolution without strategy evolution (30, 31), under environmental “shocks” to the payoff matrix (32–34), and using continuous games (22, 23, 35). Here we adopt a different approach, and we explicitly study the coevolutionary dynamics between strategies and payoffs in iterated two-player games. We decouple strategy mutations from payoff mutations, and we leverage results on the evolutionary robustness of memory-1 strategies with arbitrary payoff matrices to explore the relationship between payoff evolution and the prevalence of cooperation in a population. We identify a feedback between the costs and benefits of cooperation and the evolutionary robustness of cooperative strategies. Depending on the functional form (35) of the relationship between costs and benefits, this feedback may either reinforce the evolutionary success of cooperation or else precipitate its collapse. In particular, we show that cooperation will always collapse when there are diminishing returns for mutual cooperation.     

血友病性关节炎患者自我管理困境的质性研究

目的 了解血友病性关节炎患者自我管理的困境体验,以期为制订符合患者需求的自我管理干预方案提供参考。 方法 采用现象学研究法,选取2019年12月—2020年9月北京市某三级甲等医院骨科病房的13例血友病性关节炎患者进行半结构式深入访谈。采用Colaizzi 7步分析法分析提炼主题。 结果 对血友病性关节炎患者自我管理造成困境的原因分为内因和外因2个方面,其中内因包括早期对疾病自我管理不重视、疾病管理知识获取途径存在差异以及经济压力大;同时受到外因如疾病的不确定性、社会支持覆盖范围有限、药物可及性差以及突发公共卫生事件等困扰,最终导致血友病性关节炎患者自我管理状态不佳。 结论 血友病性关节炎患者自我管理压力大、任务重,仍存在诸多问题和障碍。医护人员可联合照顾者,通过多途径健康教育帮助患者正确认识并执行疾病管理。同时利用远程医疗平台,探索罕见病患者自我管理的新模式。     

新农合运行中的一些伦理问题及对策

新型农村合作医疗（以下简称新农合）快速顺利地推进,并达到了全面覆盖,但是在运行过程却中出现了一些有悖伦理的现象。对这些现象进行分析并找出对策,对提高新农合制度的绩效,具有十分重要的现实意义。     

生命科学技术的伦理难题及其生态超越

当代生命科学技术的生物工程特点使之无论在理论研究还是技术实践中无不面临着一系列异质而基本的“善与善”之间的价值冲突，如高新技术对传统伦理观念的可能拓展与价值颠覆、科学技术的”可行”与伦理的”应该”、生命神圣与生命价值、生命质量之间的矛盾等。这些伦理难题必须以科学家及其共同体的道德责任感为依托，同时诉诸于伦理委员会的监督评判作用的充分发挥以及生命科学技术与生命伦理的大力普及与教育等才能得以超越。     

“医养结合”养老模式的必要性、困境与对策

随着我国老龄化程度的不断加剧,老年人对医疗护理的需求与日俱增,而我国养老服务和医疗服务互不衔接,走“医养结合”之路就成为中国养老模式的必然选择。目前,我国的“医养结合”养老模式存在一些问题,如资金投入不足,服务主体参与积极性不高;服务收费水平偏高,服务内容单一僵化;政府多头管理,政策扶持落实难等。针对上述问题,我国还需进一步完善“医养结合”供给主体的服务方式,依据服务客体需求设定服务内容以及健全政府管理机制。     

Cognitive skills affect economic preferences,strategic behavior,and job attachment

Economic analysis has so far said little about how an individual''s cognitive skills (CS) are related to the individual''s economic preferences in different choice domains, such as risk taking or saving, and how preferences in different domains are related to each other. Using a sample of 1,000 trainee truckers we report three findings. First, there is a strong and significant relationship between an individual''s CS and preferences. Individuals with better CS are more patient, in both short- and long-run. Better CS are also associated with a greater willingness to take calculated risks. Second, CS predict social awareness and choices in a sequential Prisoner''s Dilemma game. Subjects with better CS more accurately forecast others'' behavior and differentiate their behavior as a second mover more strongly depending on the first-mover''s choice. Third, CS, and in particular, the ability to plan, strongly predict perseverance on the job in a setting with a substantial financial penalty for early exit. Consistent with CS being a common factor in all of these preferences and behaviors, we find a strong pattern of correlation among them. These results, taken together with the theoretical explanation we offer for the relationships we find, suggest that higher CS systematically affect preferences and choices in ways that favor economic success.     

医药卫生类高职院校学长制实施困境和路径探析

随着高等教育不断发展,现代大学管理制度和治理体系的构建亟待改进传统学生垂直型管理模式。学长制因具有学生朋辈群体之间交流的亲和性、引领性、透明性的优势,其若能有效开展将填补医学高职院校学生管理工作横向的空白,有助于实现学生管理模式从垂直型到立体复合型的转变。在医学高职院校内实施学长制学生管理模式需要在创新、选拔、培训、考核以及拓展学长制使用空间上下功夫,才能实现学长制学生管理模式的功能价值,使实施后的思想政治教育实效提升,校园更加和谐。     

R.D. Lawrence,H.G. Wells,G.B. Shaw: A Vignette

Among the unpublished autobiographical notes of Dr R.D. Lawrence are numerous references to his contacts and friendship with the author H.G. Wells, who was to become the first President of the (British) Diabetic Association. Wells was responsible for Lawrence being called in for consultation by George Bernard Shaw, a meeting which was to have surprising consequences.