正确认识精神疾病 正确对待精神病人

精神疾病是当今社会人人都必须面临的问题,我们要正确认识精神病,了解精神病发病的诱因,掌握正确的方法护理精神病人,正确对待精神病人,作好个人精神压力疏导。     

以病人为中心的医院服务组织体系构建

现实中一些医院提出“技术一流,服务一流”愿景,但是什么是“服务一流”?现有的医院体系的研究没有一个完整的思路.本文深入医院服务实践进行医院服务要素的全面调查研究,提出“以病人为中心”的医院服务组织体系构建框架,它确定了病人需求与服务使命/愿景相一致的所有要素,以确保医院的服务愿景通过一系列符合其外部环境和医院内部的所有因素的完善设计和传递来达到每一位员工都集中在服务病人需求上,这是从服务理念到服务绩效的全面全程全方位服务的系统化精益化过程,为医院服务管理者向“服务一流”目标努力提供了一个新的管理工具.     

Effectiveness of a simulated clinical examination in the assessment of the clinical competencies of entry-level trainees in a family medicine residency programme

Clinical competence is a multidimensional concept and encompasses a variety of skills including procedural, problem-solving and clinical judgement. The initial stages of postgraduate medical training are believed to be a particularly important time for the development of clinical skill competencies. This study reports on an evaluation of a Simulated Clinical Examination (SCE) method as a means of assessing the clinical skill competencies of entry-level family medicine residents. Two entering cohorts of PGY1 family medicine residents (N = 35) participated in a SCE encompassing realistic clinical encounters with standardised patients (SPs). Residents were asked to complete pre- and post-evaluation surveys, and both faculty and residents were invited to participate in separate focus groups. The SCE was perceived as a useful method during the early phases of postgraduate training for assessing clinical skill competencies, providing constructive feedback to residents and enhancing self-awareness and confidence. The SCE also appeared to be useful in fostering confidence in interviewing and diagnostic reasoning, however self-reported confidence in the ability to perform clinical skill tasks related to history taking, physical examination and differential diagnosis was not associated with observed performance in these areas. The SCE was an effective technique for benchmarking skill performance, however further research is required to evaluate the effect of this on the self-assessment abilities of trainees over the course of postgraduate medical education.     

A Study to Evaluate Lipid Profile in Treatment Naïve HIV Positive Patients

HIV infection is associated with lipid abnormalities in treatment naïve patients. CD4 count is used for monitoring the HIV infection. Primary objective was to evaluate and correlate lipid profile and CD4 counts in HIV infection. Secondary objective was to evaluate the feasibility of using Lipid profile to monitor the HIV infected treatment naïve patients instead of CD4 counts. 112 patients were selected based on a criteria from ART center in tertiary care center. CD4 counts were assessed and Lipid profile was evaluated enzymatically. A correlation study was done between the lipid profile and the CD4 count and clinical stages of infection. Cholesterol showed no significant correlation in any stage. HDL-C showed significant correlation (p < 0.05) with stage 2 and 4 disease. LDL-C showed no significant correlation in any stage. TGL showed significant correlation (p < 0.05) at stage 4 disease. Hence, HDL-C and TGL can be used as indicators of lipid status and for infection progression in treatment naive HIV patients, while Cholesterol and LDL-C has no role to play.     

浅谈老年糖尿病人的家庭护理

目的：院提高老年糖尿病人家庭护理的质量和纠正病人不良的生活习惯,使其保持良好的心理状态,活动能力,促进康复治疗。方法院通过理论研究,在家庭中对老年患者进行心理护理,饮食治疗,运动疗法,用药指导,并发症的预防,随访与记录以及健康教育。结果院防止急性并发症的发生和减低慢性并发症的风险,对已经发生的并发症进行有效控制,提高患者生活质量,延长患者寿命。结论院积极有效的家庭护理得到老年患者和社会的认可,对老年糖尿病的治疗具有关键性的作用。     

Economic Recession,Teacher-Reported Cuts to School Resources,and Children's Economic and Psychiatric Problems in Young Adulthood

The study investigated whether cuts to school resources made during economic recession contribute to children's psychiatric and economic problems in early adulthood. The cohort consisted of 817 Finnish children. Data was gathered from teachers during a recession (child age 12) and from national registers on children's post-recession use of psychiatric and income benefit services (age 18–28). Children's need for remedial instruction, special education, or psychosocial services was associated with later use of income support and psychiatric services. Those receiving special education had an increased risk for adulthood use of psychiatric services as compared to those who needed, but did not receive, this service. A decrease in material resources and teachers' loss of motivation predicted children's later use of psychiatric services.     

Applying Trans-Generational Family Theory and Therapy to College Student Psychotherapy

While family systems theory and therapy have been integrated into psychological treatment in a wide variety of populations and settings, college therapists, have been slow to find meaningful application to the treatment of students. Conflicting theoretical assumptions about the nature of the college student from the prevailing developmental model as opposed to the family theory model and lack of an elaborated model for such application may be repsonsible. A model for applying trans-generational family interventions is proposed which includes (1) family-theory informed individual therapy; (2) Bowen family "coaching"; (3) families as consultants to individual counseling; and (4) on-going family sessions. Theoretical and practical issues are illustrated through case examples.     

An Integrationist Perspective: A Response to “Bias: Thinking about College Student Psychotherapy versus Drug Treatment and Disability”

This article is written as a response to Dr. Leighton Whitaker's article: “Bias: Thinking about College Student Psychotherapy versus Drug Treatment and Disability.” The author attempts to summarize the main arguments made by Dr. Whitaker and to highlight areas of agreement as well as differences. Although the current psychiatric diagnostic nomenclature has its weaknesses, this author makes a case for using the DSM as a starting point of understanding psychopathology, but not an end point. Also, although research data on psychopharmacology trials have concerning funding and design biases, a case is made for seeing medications as a helpful adjunctive treatment for some college-aged patients, but never superseding the need for an empathic therapist–patient relationship.     

A Clinical Librarian Embedded in Medical Education: Patient-Centered Encounters for Preclinical Medical Students

Adding patient encounters and simulation to the preclinical years of medical school is becoming increasingly popular. This article describes the creation of active learning opportunities by a clinical librarian that are aimed at training preclinical students through the use of simulated patient scenarios. Scenarios for second-year students walk them through the evidence-based resources needed in clinical years and beyond through a standardized patient encounter. Scenarios for first-year students involve role-play of cases where the patient and physician bring contrasting ideas to the outpatient interaction. All scenarios are carried out under the guidance of a clinician and librarian.