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长春市二院是什么时候成立的搜医专家

2019年09月19日 21:35:49 | 作者:好活动 | 来源:新华社
When it came to pharmacological solutions to life#39;s despairs, Aldous Huxley was ahead of the curve. In Huxley#39;s 1932 novel about a dystopian future, the Alphas, Betas and others populating his ;Brave New World; have at their disposal a drug called soma. A little bit of it chases the blues away: ;A gramme; — Huxley was English, remember, spelling included — ;is better than a damn.; With a swallow, negative feelings are dispelled.说到以药物手段来医治生活中的绝望,奥尔德斯·赫胥黎(Aldous Huxley)可谓走在了时代的前面。在赫胥黎1932年的小说《美丽新世界》(Brave New World)中,生活在那个反乌托邦未来世界中的阿尔法、贝塔和其他种姓的人类手头常备一种名叫“苏麻”的万能灵药,只要一点点就可以驱散生活中的阴霾。“药胜过受煎熬。”只要吞下药丸,负面情绪也随之烟消云散。Prozac, the subject of this week#39;s documentary from Retro Report, is hardly soma. But its guiding spirit is not dissimilar: A few milligrams of this drug are preferable to the many damns that lie at the core of some people#39;s lives. Looking back at Prozac#39;s introduction by Eli Lilly and Company in 1988, and hopscotching to today, the documentary explores the enormous influence, both chemical and cultural, that Prozac and its brethren have had in treating depression, a concern that gained new resonance with the recent suicide of the comedian Robin Williams.本周(指9月22日那周)的;Retro Report;(以重新审视历史上的重大事件为主题的系列纪录片)的主题百忧解(Prozac)和“苏麻”当然不是一码事,但其宗旨却并无不同:对某些人而言,用几毫克这种药物总比应付生活中的大堆烦恼合算多了。继回顾了1988年美国礼来制药(Eli Lilly and Company)推出百忧解的经过之后,这部纪录片又将视角转回当下,从化学和文化的双重角度探讨了百忧解及其同类产品在抑郁症的治疗领域造成的巨大影响。由于喜剧演员罗宾·威廉姆斯(Robin Williams)不久前自杀,抑郁症又成为当今人们关注的热点。In the late 1980s and the 90s, Prozac was widely viewed as a miracle pill, a life preserver thrown to those who felt themselves drowning in the high waters of mental anguish. It was the star in a class of new pharmaceuticals known as S.S.R.I.s — selective serotonin reuptake inhibitors. Underlying their use is a belief that depression is caused by a shortage of the neurotransmitter serotonin. Pump up the levels of this brain chemical and, voilà, the mood lifts. Indeed, millions have embraced Prozac, and swear by it. Depression left them emotionally paralyzed, they say. Now, for the first time in years, they think clearly and can embrace life.在20世纪80年代末和90年代,人们普遍将百忧解看作是一种“神奇药丸”,是那些觉得自己快要没顶于精神痛苦中的人们眼里的救生圈。百忧解是一类名为选择性血清素再摄取抑制剂(SSRI)的新型药物中的明星产品。其作用基于的观念为,抑郁症是由一种名叫血清素的神经递质不足引起的。只要能提高这种脑化学物质的浓度,好啦,精神一下子就振奋起来了。事实上,已经有成百上千万人接受了百忧解,并对它的作用深信不疑。抑郁症导致他们情感麻痹,他们说。而今,他们终于可以清楚地思考并热情地拥抱生活了——多年来,这样的感觉还是第一次。Pharmacological merits aside, the green-and-cream pill was also a marvel of commercial branding, down to its market-tested name. Its chemical name is fluoxetine hydrochloride, not the most felicitous of terms. A company called Interbrand went to work for Eli Lilly and came up with Prozac. ;Pro; sounds positive. Professional, too. ;Ac;? That could signify action. As for the Z, it suggests a certain strength, perhaps with a faint high-techy quality.除去其药理学价值,这种半截绿色半截奶油色的胶囊丸也堪称商业品牌推广中的奇迹,而这尤其要感谢它经过市场考验的商品名。它的化学名称为盐酸氟西汀,这显然不够朗朗上口。一家名为Interbrand的公司为礼来出谋划策,想出了Prozac这个名字。;Pro;听起来就给人胸有成竹、十分专业(professional)的感觉。;Ac;呢,可以认为它表示“行动”(action)。至于Z,这个字母代表了某种力量,可能还有一点点高科技的感觉。(X is a pharmacological cousin to Z. Both letters are somewhat unusual, worth many points in Scrabble. It is surely not a coincidence that a striking number of modern medications contain either Z or X, or both, in their names, like Luvox, Paxil, Celexa, Effexor, Zantac, Xanax, Zoloft, Lexapro and Zocor, to name but a few. Not surprisingly, confusion can set in. Zantac or Xanax — remind me which one is for heartburn and which for panic disorder?)(在制药领域,X与Z的地位近似。这两个字母在取名这种拼字游戏中享有异乎寻常的地位和价值。绝大多数现代药物的商品名都包含Z或X,或两者兼而有之。随便举几个例子,Luvox[兰释,亦称无郁宁]、Paxil[百可舒]、Celexa[喜普妙]、Effexor[郁复伸]、Zantac[善胃得]、Xanax[赞安诺]、Zoloft[左洛复]、Lexapro[来士普]和Zocor[舒降之]等等。这肯定不是用巧合可以解释的。由此产生困扰也就不足为奇了。Zantac和Xanax,哪个能治胃灼热,哪个又是用以治疗惊恐障碍的?看名字可真分不清。)Pendulums, by definition, swing, and the one on which Prozac rides is no exception. After the early talk about it as a wonder pill — a rather chic one at that — a backlash developed, perhaps unsurprisingly. Grave questions arose among some psychiatrists about whether the S.S.R.I.s increased chances that some people, notably teenagers, would commit suicide or at least contemplate it. No definite link was confirmed, but that did not end the concern of some prominent skeptics, like a British psychiatrist, Dr. David Healy. He has dismissed the notion of S.S.R.I.s as saviors as ;bio-babble.;但凡事都是三十年河东三十年河西,百忧解也不例外。起初它被尊为灵丹妙药,还是种十分时髦的灵丹妙药,后来人们却又开始强烈地抵制它(或许这种反应不足为奇)。关于SSRI是否会增加某些人,特别是青少年的自杀事件或自杀倾向,精神科医生提出了严厉的质问。目前尚无研究实两者之间存在必然的关联,但是这并没有打消某些著名的怀疑论者的疑虑,英国的精神病学家戴维·希利士(David Healy)正是其中之一。他将那些把SSRI类药物当成救世主的说法贬斥为“生物噪音”。If some users deem Prozac lifesaving, others consider it sensory-depriving. A loss of libido is a common side effect. Some writers and artists, while often relieved to be liberated from depression#39;s tightest grip, also say that Prozac leaves them mentally hazy. In his 2012 book, ;Antifragile: Things That Gain From Disorder,; Nassim Nicholas Taleb offered this: ;Had Prozac been available last century, Baudelaire#39;s ‘spleen,#39; Edgar Allan Poe#39;s moods, the poetry of Sylvia Plath, the lamentations of so many other poets, everything with a soul would have been silenced.;有人觉得百忧解可以救命,其他使用者则认为它剥夺了人正常的生理感觉。百忧解的一个常见的副作用是丧失性欲。还有一些作家和艺术家声称,虽然百忧解将他们从抑郁症的魔爪之下解脱了出来,却也让他们精神恍惚。纳齐姆·尼古拉斯·塔利布(Nassim Nicholas Taleb)在他2012年的著作《反脆弱:从无序中受益》(;Antifragile: Things That Gain From Disorder;)中提出:“如果百忧解早在上个世纪就问世的话,那么波德莱尔(Baudelaire)的“忧郁”、埃德加·爱伦·坡(Edgar Allan Poe)的浪漫主义情怀、西尔维亚·普拉斯(Sylvia Plath)的诗歌、以及那么多其他诗人的哀叹,所有那些有灵魂的作品都将遭到扼杀。”Then, too, S.S.R.I. critics express doubts that these drugs have proved themselves significantly more effective than placebos. Some among them question the very concept that serotonin levels, on their own, cause depression or prevent it. One psychotherapist in that camp is Gary Greenberg, an author of several books on mood disorders. Writing in The New Yorker last year, Dr. Greenberg said that scientists had ;concluded that serotonin was only a finger pointing at one#39;s mood — that the causes of depression and the effects of the drugs were far more complex than the chemical-imbalance theory implied.;此外,SSRI的批判者们还怀疑这些药物的效果是否显著优于安慰剂。其中一些人质疑单凭血清素水平是否就足以导致或防止抑郁症。心理治疗师加里·格林伯格(Gary Greenberg)就属于这一阵营,他撰写过若干本关于情绪障碍的著作。在去年的《纽约客》(The New Yorker)上,格林伯格士写道:科学家们认为,“血清素只是影响个人情绪的一个因素,抑郁症的成因以及药物的效应远比化学失衡理论所描述的更加复杂。”;The ensuing research,; he continued, ;has mostly yielded more evidence that the brain, which has more neurons than the Milky Way has stars and is perhaps one of the most complex objects in the universe, is an elusive target for drugs.;“人的大脑中包含的神经元数量比系中的恒星还要多,”他继续写道,“而后续的研究得到的据大多表明,大脑是药物很难作用到的靶标。”More broadly, this retrospective on Prozac introduces a discussion of whether the medical establishment, and perhaps society in general, has gone too far in turning normal conditions, like sadness, into pathologies. And have we paved a path — shades of soma — toward wanton reliance on drugs to enhance life, not to conquer true illness?广而言之,这个关于百忧解的回顾性纪录片提出了这样一个论题:医疗机构,或者更宽泛一点来说,整个社会是否走得太过,以至于将普通的情感,如悲伤,也纳入了病态的范畴。我们是否正一步步地放任自己依赖药物,以增添生活乐趣——就像小说中的人们依赖“苏麻”一样——而放弃了征真正的疾病?This is what a prominent psychiatrist, Dr. Peter Kramer, has called ;cosmetic psychopharmacology,; a Botox approach, if you will, to matters of the mind: Why not take Prozac and its S.S.R.I. mates even if you are not clinically depressed but believe that they can boost your confidence, or maybe help you make a stronger pitch at the sales meeting?著名精神病学家彼得·克雷默(Peter Kramer)士将这种现象称为“美容式精神药理学”,就像是自愿给情绪问题打上一肉毒杆菌毒素一样:即使你并非临床抑郁症患者,只要你相信用百忧解及其SSRI同类可以提升你的自信心,或者能帮助你在推销会上语惊四座,那又何乐而不为呢?A response from others in Dr. Kramer#39;s field is that we are taking traits that are normal parts of human nature and casting them as diseases simply because remedies now exist. For instance, shyness is now regarded by some as a condition in need of treatment. In its more severe form, it is placed under the heading of social anxiety disorder. Then there are those much-heralded life enhancers, Viagra and its erection-aiding cousins. They are marketed not only to men with sexual dysfunction but also to those whose aging bodies are enduring normal wear and tear.克莱默士的同行中有人回应道,我们之所以将人性的正常组成部分当成疾病来对待,就是因为现在有了药。举例来说,今天有些人甚至将羞怯也归入了需要治疗的疾病,将其较为严重的形式纳入了社交焦虑症的范畴。此外,伟哥等促勃起药物也被当作能提升生活品质的东西而得到大肆炒作。在市场营销中,它们不仅被推销给需要治疗性功能障碍的男性,还被推荐给身体只是出现了正常衰老的普通人。One area of shyness that the S.S.R.I. class has helped overcome is discussion of depression. Decades ago, Hollywood stars and other celebrities dared not touch the subject. Now they routinely go public with their anguish. Robin Williams was an example.如果说SSRI类药物确实帮助人们克了某些问题,那么,使人们不再羞于讨论抑郁便是其中之一。几十年前,好莱坞明星和其他名人都对这个话题讳莫如深。现在,他们已经可以很习惯地公开谈论自己的苦恼了。罗宾·威廉姆斯就是一个例子。Of course, there are those in other realms of society for whom the topic remains taboo. Take one man who confesses to his wife that he is on Prozac but cautions her to tell no one. ;I#39;m serious,; he says. ;The wrong person finds out about this and I get a steel-jacketed antidepressant right in the back of the head.; This is Tony Soprano talking to his wife, Carmela. An extreme example from a work of fiction? Sure. But in all likelihood many Americans have similar fears about what others might think, and keep depression to themselves.当然,在其他社会领域中,有些人仍然十分忌讳这个话题。例如,有一个人在向自己的妻子承认他在用百忧解时,警告她不要告诉任何人。“我是说真的,”他说。“要是给不该知道的人听到点风声,我就得脑袋后面吃颗钢制的抗抑郁药。”这是《黑道家族》中的托尼·索普拉诺(Tony Soprano)对他的妻子卡尔梅拉(Carmela)说的话。这自然只是虚构作品中的一个极端的例子。但是,在美国人里,恐怕很多都会对别人的看法抱有类似的担忧,所以他们宁愿对自己的抑郁问题守口如瓶。 /201410/336081Edward Snowden and the NSA leaks合同工斯诺登踢爆美国国安局监控行动Without question, the scandal of the year: The U.S. government still doesn#39;t know the number of secrets Edward Snowden, the National Security Agency contractor-gone-rogue, snuck out of the country with last June. The strands to this scandal are many: from the extent of government spying at home and abroad to the ease with which a single contractor got a security clearance, fled the country with untold amounts of sensitive data, and outran that government on a wild goose chase. And the scandal, of course, is still unfolding.毫无疑问,这是今年最大的丑闻:美国政府至今仍不确定爱德华#8226;斯诺登到底掌握了多少秘密。这位“潜伏”在美国国家安全局(National Security Agency,NSA)的合同工于去年六月秘密逃往国外。这起丑闻涉及多个方面,比如:政府在国内外进行暗中监控的程度,合同工竟然可以轻易获得安全许可,掌握大量敏感数据的斯诺登能够顺利逃往国外,而政府只能望洋兴叹。目前,这出闹剧仍未收场。 /201401/271587

When one is the monarch, one is used to being given a comfy seat in the front row.君主通常都习惯坐在舒的前排座位上。But yesterday the Queen found herself perched several rows back as she watched the Commonwealth Games swimming heats.然而昨天,英女王去观看英联邦运动会游泳预赛时却发现自己被安置在了倒数几排的位子上。She was given an ordinary plastic seat and then found her view obscured by a woman in a rather large hat.她坐的是普通塑料椅,而且很快发现自己的视线被前面一个带着大帽子的女士给挡住了。The offending spectator was her own lady-in-waiting, the Hon Annabel Whitehead, who made matters worse by having chosen a very similar shade of green in which to dress.这位冒犯女王的观众就是女王自己的侍女霍恩·安娜贝尔·怀特海德,而且更糟糕的是,她穿的绿色套裙与女王的着装颜色非常相近。Queen Elizabeth II spent most of her afternoon trying to improve her view - which was somewhat obscured by her lady-in-waiting#39;s enormous green hat.由于视线被侍女巨大的绿色帽子给挡住了,女王几乎一下午都在努力获得更好的视角。As the swimming races got off to an exciting start below, she could be seen craning her neck to try and get a better view over Mrs Whitehead.看台下,游泳比赛如火如荼地开始了,而她只能伸着脖子,试图避开怀特海德夫人看得更清楚些。The Queen began to look dejected as she dodged around her lady-in-waiting to catch a glimpse of the heats of the men#39;s 50m and women#39;s 100m butterfly.为了瞧一眼男子50米和女子100米蝶泳预赛,女王一直在努力避开侍女的遮挡,渐渐地看上去有些沮丧。At one point, she even appeared to sit back in exasperation, as fellow spectators around her got heavily involved in the races.有一刻,她甚至好像有点生气,直接往背后一靠,而她周围的观众倒是看得全神贯注。But it seemed the Queen was too polite to ask her lady-in-waiting to move - and instead spent her time dodging around Dame Whitehead as she moved position.不过,女王似乎不大好意思开口让自己的侍女让一让,所以只好随着侍女坐姿的变化不断调整视线。Dame Whitehead, 71, had aly risked royal disapproval by wearing a green ensemble similar to the Queen#39;s - which actually appeared to clash.71岁的怀特海德夫人还穿了一条与女王着装颜色很相近的绿色套裙,很显然撞了色,差点遭到皇室的反对。 /201407/315426

More than 23 millionprocedures were performed in 20132013年,美容治疗案例超过两千三百万Cosmetic surgery is booming worldwide as peopleflock to have millions of operations including breast augmentation, liposuctionand Botox.整容行业在全球范围内蓬勃发展,有数以百万计的人接受了包括隆胸、吸脂和注射肉毒杆菌等手术项目。More than 23 million cosmetic and non-surgicalprocedures were performed in 2013, according to the International Society ofAesthetic Plastic Surgery (ISAPS).根据国际美容整形外科学会提供的数据,2013年,实施美容和非手术治疗的人超过两千三百万例。The ed States topped the international chart,with almost 4 million people going under the knife or needle, followed byBrazil with more than 2 million procedures.美国高居国际排行榜首位,有近4百万人民挨针动刀,巴西以超过两百万的数据紧随其后Britain did notfeature in the top 10 but was ranked 14 in the world by the number of plasticsurgeons, with an estimated 865 in business.不列颠整容数量未能挤进世界前10,屈居14,估计约有865例Figures released bythe British Association of Aesthetic Plastic Surgeons (BAAPS) earlier this yearshowed 17 per cent more operations were performed in the UK in 2013 but thecount of 50,122 did not include non-surgical procedures reflected in the ISAPSfigures.由英国美容整形外科医师协会今年早些时候公布的数据来看,2013年英国实施的整形手术占到百分之17还多,但是有50122例没有进入国际美容整形外科学会的非手术治疗数据A spokesman for BAAPS said little information onthe treatments can be collected in Britain because dermal fillers and lasertreatments are unregulated.英国美容整形外科医师协会发言人说一部分信息没有被计数,因为皮肤填充和激光治疗不受监管Botox is the most popular cosmetic procedure inthe world. The toxin, which can be lethal, is injected to paralyse facialmuscles to slow down the ageing process.注射肉毒杆菌是最受世界欢迎的项目。这种毒素,是致命的,被注射到面部麻痹肌肉来减缓衰老Other popular non-surgical treatments includedfillers, laser hair removal and chemical peels.其他受欢迎的非手术治疗包括填料、激光脱毛和化学换肤More than 1.7 million breast operations wereperformed last year, making it the most popular cosmetic surgery worldwide,followed by liposuction, eyelid surgery, lipostructure and rhinoplasty.去年有超过一百七十万例的隆胸手术被实施,这使它在世界范围内成为最流行的整容手术,其他受欢迎的还包括吸脂,眼睑手术,唇形构建和鼻整形术。Women were by far the biggestconsumers in the cosmetic surgery market, making up almost 90 per cent of allprocedures in the world – more than 20 million.迄今为止女性是整容市场的最大消费群,几乎占据世界市场份额的百分之九十——超过两千万Men underwent more than 3 million procedures,mostly rhinoplasty, breast reduction and eyelid surgery.接受手术的男性有三百多万,大多数是隆鼻术、 乳房缩小和眼睑手术Penis enlargements were most popular in Germany,where almost 3,000 men had the operation, followed be Venezuela, Spain andMexico.阴茎增大术在德国最受欢迎,大约有3000名男性接受了该手术,其次是委内瑞拉、西班牙和墨西哥According to BAAPS, “boob jobs”, eyelid surgeryand facelifts are most popular among women in the UK, while men prefer nose andeyelid surgery, as well as breast reductions.英国美容整形外科医师协会所说,隆胸、眼睑手术和拉皮手术在不列颠最受女性欢迎,而男性则更喜欢隆鼻、割双眼皮和缩胸手术Rajiv Grover, a consultant plastic surgeon andPresident of BAAPS, said the number of procedures has rocketed as the economyrecovers.整形顾问、英国美容整形外科医师协会主席,拉吉夫 ·格罗弗说,随着经济的复苏,整形手术的数量也一路飙升 /201408/317115

Using a computer or smartphone at night can cause us to pile on the pounds, new research has revealed.最新的研究表明,在夜晚使用电脑或者智能手机可能会让我们的体重增加好几磅。The study found a link between blue light exposure - blue light is emitted by smartphones and tablets - and increased hunger.它发现饥饿感与受智能手机和平板电脑产生的蓝光照射有关。It found that exposure to the light increases hunger levels for several hours and even increases hunger levels after eating a meal.并且,被此光线照射会增加数小时的饥饿感,甚至是刚刚吃过饭的人,饥饿感也会增加。Results of the US study show that blue-enriched light exposure, compared with dim light exposure, was associated with an increase in hunger that began 15 minutes after light onset and was still present almost two hours after the meal.这项来自美国的研究结果显示,相对于昏暗的光线辐射来说,在被明亮蓝色光线照射15分钟后,饥饿感便会开始增加。这种饥饿感在饭后近两小时内都会存在。Blue light exposure has also aly been shown to decreased sleepiness in the evening increasing the risk of insomnia.同时,蓝光照射已被实会减少夜间的困意,从而增加患上失眠症的风险。Study co-author Ivy Cheung, of Northwestern University, in Chicago, said: ‘A single three-hour exposure to blue-enriched light in the evening acutely impacted hunger and glucose metabolism.研究者之一,来自芝加哥西北大学的张艾薇称:“夜晚被明亮蓝光照射三个小时,会对饥饿感和葡萄糖代谢有着极大的影响。”‘These results are important because they suggest that manipulating environmental light exposure for humans may represent a novel approach of influencing food intake patterns and metabolism.’“该研究之所以意义重大,是因为其结果表明,控制人体周围环境的光线照射或许是一种可左右饮食摄入方式和新陈代谢的新方法。”The findings are published in the science journal Sleep and were presented today at an annual meeting of the Associated Professional Sleep Societies in Minneapolis.这项研究成果发表于学术期刊《睡眠》,并于今天在明尼阿波利斯举行的睡眠协会年会上发布。The study group comprised 10 healthy adults with regular sleep and eating schedules who received identical carbohydrate-rich meals.实验的研究对象是10位有着规律睡眠和饮食时间的健康成人。在研究期间,他们每日摄入完全相同的高碳水化合物食物。They completed a four-day trial under dim light conditions, which involved exposure to less than 20 lux during 16 hours awake and less than three lux during eight hours of sleep.他们在昏暗光线环境下完成了一个为期四天的实验:在每日16小时的清醒状态下接受低于20勒克斯的光照;而在8小时的睡眠期间接受低于3勒克斯的光照。On day three they were exposed to three hours of 260 lux, blue-enriched light starting 10.5 hours after waking up, and the effects were compared with dim light exposure on day two.第三天,研究对象在起床10.5小时后的3小时内受到了260勒克斯的明亮蓝光照射,再将其实验结果与实验第二天用昏暗光线照射的结果进行了对比。Ms Cheung said more research is needed to determine the mechanisms of action involved in the relationship between light exposure, hunger and metabolism.张女士表示,光线照射对人体饥饿和新陈代谢关系的原理仍然需要进一步的研究明。 /201406/307750

BOSTON — David Baldwin wasn#39;t sure how he had come across the other day in group therapy at the hospital, near the co-op apartment where he lives with his rescue cat, Zoey. He struggles with bipolar disorder, severe anxiety and depression. Like so many patients, he secretly wondered what his therapist thought of him.波士顿——大卫·鲍德温(David Baldwin)和他救助的猫咪佐伊(Zoey)共同居住的合作公寓附近有家医院,不久前的一天,他在那里参加了一次团体治疗,但并不确定自己当时给人留下了怎样的印象。鲍德温一直在与会让人陷入极度焦虑和沮丧之中的躁郁症做斗争。和很多患者一样,他会暗自揣测治疗师对他的看法。But unlike those patients, Mr. Baldwin, 64, was able to find out, swiftly and privately. Pulling his black leather swivel chair to his desk, he logged onto a hospital website and eagerly perused his therapist#39;s session notes.但与其他患者不同, 64岁的鲍德温能迅速地、悄悄地找到。他把黑色皮转椅拖到自己的书桌前,随后登录到医院的网站,急切地看起了他的治疗师对那次会谈的记录。The clinical social worker, Stephen O#39;Neill, wrote that Mr. Baldwin#39;s self-consciousness about his disorder kept him isolated. Because he longed to connect with others, this was particularly self-defeating, Mr. O#39;Neill observed. But during the session, he had also discussed how he had helped out neighbors in his co-op.临床社工斯蒂芬·奥尼尔(Stephen O#39;Neill)写道,鲍德温对他的疾病感到尴尬,这让他处于孤立的状态。奥尼尔注意到,该状态给他带来了强烈的挫败感,因为他渴望与人交往。但在治疗期间,他也曾谈论过自己是如何给合作公寓里的邻居们帮忙的。;This seems greatly appreciated, and he noted his clear enjoyment in helping others,; Mr. O#39;Neill wrote. ;This greatly assists his self-esteem.;“人们似乎非常感谢他,他则明显感到帮助别人时他自己也乐在其中,”奥尼尔写道,“这可以非常有效地帮他建立自尊心。”A smile animated Mr. Baldwin#39;s broad, amiable features. ;I have a tough time recognizing that I#39;ve made progress,; he said. ;So it#39;s nice to this as a reminder.;鲍德温宽和的脸庞上掠过了一丝微笑。“我很难确认自己已经有所进步,”他说,“阅读这些内容让我得到了提示,真不错。”Mental health patients do not have the y access to office visit notes that, increasingly, other patients enjoy. But Mr. Baldwin is among about 700 patients at Beth Israel Deaconess Medical Center who are participating in a novel experiment.心理疾病患者是无法便捷地查询门诊病历的,尽管罹患其他疾病的患者已经逐渐可以这样做了。但包括鲍德温在内,以色列堂-女执事医疗中心(Beth Israel Deaconess Medical Center)的大约700名患者正在参与一场新奇的实验。Within days of a session, they can their therapists#39; notes on their computers or smartphones. The hope is that this transparency will improve therapeutic trust and communication.参加完会谈数日后,他们就可以在自己的电脑或者智能手机上阅读治疗师做的记录了。提高信息透明度的目的,是希望加深医患之间的信任和沟通。;We#39;re creating a revolution,; said Dr. Tom Delbanco, a professor of medicine at Harvard and a proponent of giving patients access to notes by therapists as well as by physicians. ;Some people are aghast.;“我们正掀起一场革命,”主张允许患者查看治疗师及医生所做记录的哈佛大学(Harvard)医学教授汤姆·德尔班科(Tom Delbanco)表示,“有些人被惊呆了。”The pilot project has raised questions in the mental health community. Which patients will benefit and which might be harmed? How will the notes alter a therapeutic relationship built on face-to-face exchanges? What will be the impact on confidentiality and privacy?这一试点项目已经在心理健康群体内引发了争议。哪些患者会从中受益,哪些又会受到伤害?病历将如何改变基于当面交流的医患关系?对保密性和隐私权又会有什么样的影响?And the project presents difficult choices for those who argue for parity between medical and mental health patients. Should patients with schizophrenia, for example, who may stop taking their medication after ing that they are doing well, have the same access to treatment notes as those with irritable bowel syndrome?该项目也让主张同等对待内科和心理疾病患者的人面临艰难的抉择。举例来说,精神分裂症患者如果读到关于自己的病情正在好转的内容,或许会停止用药,他们也该和肠易激综合征患者享有同等的查阅诊疗记录的机会吗?But the lingering underlying question is, do patients really want to know what their therapists think? Dr. Kenneth Duckworth, who is the medical director of the National Alliance on Mental Illness, an advocacy group, said: ;I#39;ve offered to share my notes with patients and they#39;ll say, #39;No, I#39;m good.#39; But it#39;s a good concept that should be researched.;在人们脑海中徘徊的根本问题则是,患者真的想知道他们的治疗师是怎么想的吗?倡导组织“全国心理疾病联盟”(National Alliance on Mental Illness)的医务主任肯尼思·达克沃斯(Kenneth Duckworth)士表示:“我已经表示愿意和病人分享我做的记录,而他们会说#39;不用了#39;。但它是一个值得研究的好想法。”The practice is so new that it is too early for a comprehensive evaluation. The Department of Veterans Affairs, which began making medical and mental health records available online last year, is only just beginning to study the effect on mental health patients.这种做法非常新颖,对其加以综合性评估还为时尚早。去年着手把内科和心理疾病病历放在网上以便查阅的退伍军人事务部(Department of Veterans Affairs),也不过刚刚开始研究该做法对心理疾病患者的影响。Older studies from psychiatric wards where patients charts with doctors found that the patients were confused or offended by the content. But as doctors helped interpret their notes, patients began participating more in their care and trusting their team.此前有人研究过心理病房的患者与医生共同阅读病历的情形,其结果表明:一些内容会让患者感到困惑和受了冒犯,但在医生帮忙加以解释后,患者开始更多地参与治疗,也更信任他们的治疗团队。Although Beth Israel therapists report that some patients have no interest in ing their notes, responses from a few have been positive and powerful.尽管以色列堂-女执事医疗中心的治疗师表示,某些患者没兴趣阅读病历,但还是有患者做出了积极的、强烈的响应。Stacey Whiteman, 52, a former executive secretary in Needham with multiple sclerosis, faces growing cognitive as well as physical difficulties. The disease has shaken her self-image and relationships; her psychological health affects her willingness to manage the disease. She finds that her medical and mental health notes complement each other.尼德汉姆(Needham)公司前行政秘书斯泰西·怀特曼(Stacey Whiteman)患有多发性动脉硬化症,面临着身体和认知上的双重问题。这种疾病损害了她的自我形象和人际关系;糟糕的心理健康状况影响了她控制病情的意愿。她发现,内科和心理疾病病历是互为补充的。;Yes, the therapy notes can be hard to , and sometimes I wonder, #39;Really, I said all of that?#39; ; she said. ;But there#39;s no question that ing this stuff just charges you back up to moving forward.;“不错,诊疗记录可能很难读,有时候我会怀疑,#39;我真的说过这些话吗?#39;”她说,“但毫无疑问,阅读这些东西可以督促你继续接受治疗。”While such a program may be feasible in larger systems like Beth Israel, a Harvard hospital, some solo practitioners fear it may require too much time and technological sophistication.以色列堂-女执事医疗中心是哈佛大学的一所附属医院。在此类规模较大的机构里,这样一个项目或许是可行的。但有些个体从业者担心它太耗费时间,在技术上太过复杂。But Peggy Kriss, a psychologist in Newton, is an early adopter. For over a year she has maintained a website with private pages for patients on which she posts session notes, as well as articles, s and meditations.不过,牛顿市的心理学家佩吉·克里斯(Peggy Kriss)是一位先行者。一年多来,她一直在维护一个由务于患者的私人网页构成的网站。除了会谈记录,她还会在上边发布文章、视频以及自己的一些思考。Toward the end of each session, she and the patient begin the note together defining the key points that have been raised.每次治疗结束前,她会和病人一起着手整理会谈记录的内容,厘清此前提到的重点问题。Dr. Kriss said that for most of her patients, online notes have become the new normal. One described them to her as a security blanket between appointments.克里斯医生称,对她的大多数患者而言,线上记录已经成了一种新的常态。一位病人将其形容为两次会谈间隙的慰藉。Some write replies. ;An O.C.D. patient told me I was spelling things wrong,; Dr. Kriss said. ;So I said, #39;I#39;m just modeling anti-perfectionism for you.#39; ;有些患者会回帖。“一位强迫症患者告诉我,我犯了些拼写错误,”克里斯医生说,“于是我回应道,#39;我只是在为你示范什么叫反完美主义。#39;”The Beth Israel project grew out of OpenNotes, a program by Dr. Delbanco and his colleagues that made physicians#39; notes accessible to 22,000 patients at three institutions. A 2011 study showed that patients responded positively and became more involved in their care.以色列堂-女执事医疗中心的项目脱胎于由德尔班科士及其同事发起的“公开病历”(OpenNotes)计划。该计划让三家医疗机构的2.2万名患者得以查阅医生做的记录。2011年的一份调查报告显示,患者们做出了积极的响应,开始对治疗更为投入。More systems are adopting the model. At least three million patients now have swift access to office visit notes, including observations and recommendations.更多的医疗机构正在采用这种模式。眼下,至少有300万名患者可以便捷地查阅包括医生意见和建议在内的门诊病历。But even those institutions have hesitated to share mental health notes. Critics have raised concerns about whether ing notes could prompt anxiety and even rejection of treatment. What will happen if the patient posts the notes on Facebook, inviting comment?但即便是这些机构,也不愿贸然与心理疾病患者分享病历。批评者担心的是,阅读病历是否有可能让患者感到焦虑,进而抗拒治疗。要是患者把病历放在Facebook上,请人发表看法,又会发生什么事呢?Proponents of access point out that such notes, which include extensive diagnostic reports, are aly available to other doctors and to insurers.主张允许心理疾病患者查询病历——包括大量诊断报告在内——的人士指出,这类病历已经对其他医生以及保险商开放了。Although patients have long had the right to their records, the process to obtain copies can be protracted. If a doctor thinks that ing notes would be harmful to the patient or others, they can be withheld.尽管长期以来患者一直有权获得病历的复印件,但相关程序可能拖拖拉拉。如果医生认为阅读病历会对患者或其他人造成伤害,则可能拒绝提供病历。Mindful of such pitfalls, the Beth Israel psychiatrists have offered notes initially to only 10 percent of patients. Clinical social workers are making notes more widely available, though some therapists have temporarily opted out. Nina Douglass, a social worker in the ob-gyn clinic, worries about patients with abusive partners. If the abuser insisted on ing the notes, the patient could be in danger.考虑到此类潜在的困难,以色列堂-女执事医疗中心的心理医生初步只向10%的患者提供了病历。临床社工们正把病历提供给更多患者,但一些治疗师暂时选择了退出。妇科门诊部的社工尼娜·道格拉斯(Nina Douglass)担心,有些患者的伴侣言语恶毒。如果这样的人坚持要阅读病历,可能会将患者置于险境。;I can imagine that our work can be deepened and enhanced through people ing their notes,; Ms. Douglass said. ;But one size doesn#39;t fit all.;“可以想见,通过让病人阅读他们的病历,我们的工作能得到深化和加强,”道格拉斯说,“但不能搞#39;一刀切#39;。”Mental health notes have very different ers: the therapist, who may use them as a memory prompt; other doctors treating the patient; insurers; and now the patient. Writing a note with necessary information for all can be daunting.心理疾病病历有各种各样的读者:把病历当成记事本来用的治疗师;治疗该病人的其他医生;保险商;现在又多出了患者本人。书写一份包含各方所需信息的病历可能是一项艰巨的任务。Mr. O#39;Neill, the social work manager, is pressing therapists to use straightforward descriptions. ;I used #39;affect dysregulation,#39; and a patient said, #39;What on earth is that? Are you saying I#39;m totally crazy?#39; ; he said. ;It just means they can get upset. So why not use the word #39;upset#39;?;身为社会工作管理者的奥尼尔一直在敦促治疗师们使用简单易懂的措辞。“有一次我用了#39;情绪失调#39;,一个病人问道:#39;这究竟是什么东西?你的意思是我完全疯掉了?#39;”他说,“其实它只不过意味着患者可能会感到沮丧。那么何不就用#39;沮丧#39;这个词呢?”Some psychiatrists disagree.一些心理医生对此各持己见。;Diagnostic language is used among doctors to describe features of a mental illness,; said Dr. Brian K. Clinton, an assistant professor at Columbia University Medical Center who has written about sharing records. ;I would be willing to discuss with a patient what I think. It#39;s a better way to communicate than a note I wrote for other doctors.;“诊断用语是医生群体用来描述心理疾病特征的工具。”以病历分享为题写过文章的哥伦比亚大学医学中心(Columbia University Medical Center)助理教授布莱恩·K·克林顿(Brian K. Clinton)士表示,“我愿意和患者讨论我的想法。比起让患者阅读我写给其他医生看的病历,这种交流方式更好一些。”But Dr. Michael W. Kahn, an assistant professor of psychiatry at Harvard Medical School who wrote about the project in JAMA, said that if the therapist explained the diagnosis, some patients might feel relieved, knowing their behavior fits a pattern that others also experience.但在美国医学会杂志(JAMA)上撰文探讨过该项目的哈佛大学医学院(Harvard Medical School )心理学助理教授迈克尔·W·卡恩(Michael W. Kahn)士说,如果治疗师对诊断加以解释,一些患者或许会感到如释重负,因为了解到其他一些人有着跟他们雷同的行为模式。Dr. Glen O. Gabbard, a psychiatrist and professor at Baylor College of Medicine, said that opening notes to patients might have a chilling effect on doctors.贝勒医学院(Baylor College of Medicine)的心理医生及教授格伦·O· 加巴德(Glen O. Gabbard)士称,向患者公开病历,可能会让医生不愿表达看法。;A psychiatrist would be less likely to put down anything he is musing about as diagnostic possibilities or write about what he feels the patient is leaving out,; he said.他说,“心理医生不太可能像从前那样,写下他所考虑到的一切诊断可能性,或者写下他觉得患者并未和盘托出的一些事情。”Mr. Baldwin#39;s longtime friends know about his harrowing battles with mental illness: The hospitalizations. The manic episodes. The depression. The anxiety so crippling that two years ago, at a Costco parking lot, he couldn#39;t get out of the car.鲍德温的老朋友们都知道他和心理疾病作战的惨痛经历:住院治疗;躁狂发作;抑郁;以及极具破坏力的焦虑——两年前,他甚至在好市多(Costco)的停车场里无法下车。As he withdrew into his apartment, pints of ice cream, Zoey, and the telephone became his constant companions. During the worst sieges of anxiety, he would call a few friends three, four times a day.他曾蜷缩在公寓里,成天与冰淇淋、佐伊和电话为伴。压力最大的那些日子,他每天要给少数几个朋友打三四个电话。That is the man they recall, he recounted in his freshly tidied apartment. Its décor is hopeful: a multicolored rug, violet curtains, a jaunty lime-green wall.这就是他们记忆中的那个男人——他在刚刚整理过的公寓里讲述着自己的经历。公寓内部的装潢给人以充满希望之感:地毯五缤纷,窗帘是紫色的,墙壁是生机勃勃的浅绿色。And so is Mr. Baldwin. He is trying to lose weight, maybe someday have a new man in his life.鲍德温本人也是如此。他正努力减肥,期盼着有一天或许会在生活中迎来一个崭新的自己。He clicked open another therapy note.他点开了另一份诊疗记录。Mr. Baldwin ;is continuing to try to push himself to get out more and to be more socially connected even while his emotions tell him to do the opposite,; Mr. O#39;Neill wrote, adding that his patient is ;clearly making good, and even courageous, efforts on a number of fronts.;“鲍德温仍在竭力敦促自己更多地走出去,更多地跟他人交往,尽管从情感上来说,他更愿意反其道而行之,”奥尼尔如此写道。他还说,他的病人“显然正虔诚地,甚至可以说是勇敢地做着多方面的努力。”Mr. Baldwin, who celebrated his birthday recently with a museum lecture, movie and dinner, flushed with pride.不久前刚以去物馆听讲座、看电影、吃大餐的方式庆祝了的生日鲍德温,因为自豪而涨红了脸颊。;I#39;m going to email this to my friends,; he said.“我要把这些话用邮件发给朋友们,”他说。 /201410/338016

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